Meeting Unmet Needs for Stroke Rehabilitation in Rural Public Health: Explorative Economic Evaluation of Upper Limb Robotics-Based Technologies through a Capabilities Lens
Abstract
:1. Introduction
2. Materials and Methods
2.1. The Setting
2.2. The Assistive Technology Implemented
2.3. The Economic Evaluation Approach
2.4. Ethical Considerations
2.5. Phases of the Analysis
2.5.1. Phase 1: Clinical Impact of the Robotics Program Compared to Usual Care
2.5.2. Phase 2: Economic Impact of the Robotics Program Compared to Usual Care
2.5.3. Phase 3: Costs and Opportunity Costs from the Patient and Carer Perspective
2.5.4. Phase 4: Description of the Cost Effectiveness of the Robotics Program Compared to Usual Care
- That a patient receiving usual care 1:1 out-patient rehabilitation therapy would be able to access an intensity equivalent to the RBT program.
- That a patient receiving usual care 1:1 out-patient rehabilitation therapy would be managed by a Grade 2 clinician (or above).
- That an Allied Health Assistant completes the set up and pack up for the RBT program and the usual care 1:1 out-patient rehabilitation therapy, and that this has been included as a part of the program on-costs.
- That administrative staff complete all administration duties for the RBT program and the usual care 1:1 out-patient rehabilitation therapy, and that this has been included as a part of the program on-costs.
- That any costs associated with a home exercise program for both the RBT program and the usual care 1:1 out-patient rehabilitation therapy have been included as a part of the program on-costs.
3. Results
3.1. Clinical Impact of the Robotics Program Compared to Usual Care
3.1.1. Outcome Measures
3.1.2. Economic Impact of the Robotics Program
3.1.3. Cost Analysis
3.1.4. Capital Costs for the Robotics Equipment and Education Costs for the Robotics Program
3.1.5. Staff Costs for the Robotics Program and for Usual Care
3.2. Costs and Opportunity Costs from the Patient and Carer Perspective
3.2.1. Travel Costs for the Patient
3.2.2. Productivity Opportunity Costs for the Carer
3.2.3. Robotics Program Out-of-Pocket Fees
3.2.4. Description of the Cost Effectiveness of the Robotics Program Compared to Usual Care
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Classification | Code | Base Hourly | Total Hourly + 20.5% On-Costs | |
---|---|---|---|---|
Grade 1 Clinician | Grade 1 Year 4 | VA5 | AUD 32.78 | AUD 39.52 |
Grade 2 Clinician | Grade 2 Year 2 | VB2 | AUD 39.30 | AUD 47.39 |
Grade 3 Clinician | Grade 3 Year 2 | VB8 | AUD 44.89 | AUD 54.13 |
Allied Health Assistant | Grade 3 | TC2 | AUD 28.13 | AUD 33.93 |
Element | Unit Description/Data Source | Unit | Cost Per Unit |
---|---|---|---|
Pre-robotics health service costs, AUD 2018/19 | |||
Acute admission | Cost of an acute hospital admission per diem [29] | 1 day | AUD 2104.76 |
Rehabilitation admission | Cost of a rehabilitation hospital admission per diem [29] | 1 day | AUD 1124.36 |
Out-patient sessions | Cost of an out-patient rehabilitation session with an allied health professional for 45 to 60 minutes duration [31] | 1 hour | AUD 94.96 |
Set Up Cost Element, AUD 2018/19 | Unit Description/Data Source | Unit | Cost Per Unit (s) |
---|---|---|---|
Capital costs of equipment, AUD Amadeo Tymo Pablo Able X mouse and handbar Saebo Re-joyce Kidney shaped tables High low tables Laptops | Health service equipment purchase orders from 2017/18 with CPI applied for 2018/19 net present value [3] | 1 robotics device 1 robotics device 1 robotics device 1 robotics device 1 robotics device 2 tables 2 tables 3 laptops | AUD 85,764 AUD 10,618 AUD 12,252 AUD 2042 AUD 20,341 AUD 2042 AUD 2042 AUD 3063 |
Maintenance and consumables associated with the equipment | 25% of the capital cost of equipment [33] | 25% of capital costs | AUD 35,645.91 |
Provision of staff education, AUD | Health service salary calculator based on Grade 3 Year 4 wage classification for an OT/PT 1 hour = AUD 54.61 AUD 45.29 × 1.2057 (20.57% on-costs) | 8 hours preparation 2-hour workshop 2 × 1-hour group education 15 × 1-hour individual education TOTAL 27 hours | AUD 1474.47 |
Receipt of staff education, AUD | Health service salary calculator based on an average Grade 2 Year 1 wage classification for an OT/PT 1 hour = AUD 45.31 AUD 37.57 × 1.2057 (20.57% on-costs) | 2-hour workshop (15 attendees) 2 × 1-hour group education (10 attendees) 15 × 1-hour individual education TOTAL 65 hours | AUD 2945.15 |
TOTAL SET UP COSTS | AUD 178,229.53 | ||
Cost of space | Each robotics program requires 18 half days of space (AUD 8.49 × 18 days × 1/2 day) for a total space cost of AUD 76.41 per program [33] | A 1/2-day session | AUD 4.25 |
Outcome | Usual Care Cohort (n = 10) | Robotics Cohort All Participation (n = 20) | Robotics Cohort First Program Participation (n = 14) | Robotics Cohort Second or Third Program Participation (n = 6) | Difference between Groups for Change Score (First Time Robotics Minus UC) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Baseline | Post Intervention | Baseline to Post Change Score | Baseline | Post Intervention | Baseline to Post Change Score | Baseline | Post Intervention | Baseline to Post Change Score | Baseline | Post Intervention | Baseline to Post Change Score | ||
FIM total, score (SD) | n = 4 111.8 (15.6) | n = 2 125.0 (1.4) | n = 2 2.5 (3.5) | n = 18 100.9 (13.4) | n = 15 102.5 (13.9) | n = 15 3.7 (5.1) Usual care to ALL robotics p = 0.73 | n = 12 99.7 (13.9) | n = 11 99.6 (13.4) | n = 11 2.1 (4.7) Usual care to FIRST robotics p = 0.90 | n = 4 103.5 (13.2) | n = 4 110.50 (13.6) | n = 4 8.0 (3.6) Usual care to 2nd/3rd Robotics p = 0.21 | 0.4 (95%CI −14.1 to 15.0) p = 0.90 |
Euro QOL 5D3L, VAS (SD) | NA | NA | NA | n = 19 70.26 (15.4) | n = 18 69.11 (18.6) | n = 18 −1.15 95%CI (−10.29 to 12.60), p = 0.839 | n = 13 68.4 (15.5) | n = 13 71.8 (17.3) | n = 12 1.25 95%CI (−4.0 To 6.5) p = 0.61 | n = 6 74.3 (15.8) | n = 5 62.2 (22.0) | n = 5 −9.0 95%CI (−40.2 To 22.2), p = 0.47 | NA |
Euro QOL 5D3L, utility index (SD) | NA | NA | NA | n = 20 0.63 (0.1) | n = 18 0.63 (0.1) | n = 18 0.001 95%CI (−0.077 to 0.737), p = 0.970 | n = 14 0.63 (0.09) | n = 13 0.62 (0.9) | n = 13 −0.001 95%CI (−0.07 to 0.07) p = 0.99 | n = 6 0.63 (0.17) | n = 5 0.66 (0.12) | n = 5 0.010 95%CI (−0.22 to 0.24) p = 0.91 | NA |
Characteristic | Usual Care Cohort (n = 10) | Robotics Cohort (n = 20) | Mean Difference and Significance (Usual Care to First Time in the Robotics Program) | ||
---|---|---|---|---|---|
All Participation (n = 20) | First Program Participation (n = 14) | Second or Third Program Participation (n = 6) | |||
Age, years (SD) | 71.0 (10.7) | 66.3 (7.3) | 66.3 (7.9) | 66.4 (6.6) | 4.8 years p = 0.23 |
Gender, n (%) Female | 3 (30%) | 12 (60%) | 7 (50%) | 5 (83%) | p = 0.32 |
Years from onset to baseline assessment, years (SD) | 0.21 (0.33) | 0.84 (1.29) | 0.67 (0.79) | 1.2 (2.1) | −0.45 years p = 0.08 |
Distance from home to community care centre, KMs (SD) | 27.6 (27.7) | 47.7 (30.1) | 49.9 (35.6) | 42.6 (10.4) | −22.2 km p = 0.10 |
Transport, n (%) Carer driven car Self–driven car Walk Other | 8 (80%) 0 (0%) 1 (10%) 1 (10%) | 16 (80%) 1 (5%) 0 (0%) 3 (15%) | 11 (79%) 0 (0%) 0 (0%) 3 (21%) | 5 (83%) 1 (17%) 0 (0%) 0 (0%) | p = 0.53 |
Diagnosis | 10 (100%) | 20 (100%) | 14 (100%) | 6 (100%) | p = 1.00 |
Dominant hand affected, n (%) yes | 1 (10%) (Unknown n = 8) | 9 (45%) | 6 (43%) | 3 (50%) | p = 0.00 * |
Pre-existing UL condition, n (%) yes | 1 (10%) | 4 (20%) | 3 (21%) | 1 (17%) | p = 0.26 |
Element | Usual Care Cohort (n = 10) | Robotics Cohort (n = 14) | Mean Difference (95%CI) | Significance |
---|---|---|---|---|
Pre-robotics total (SD) Acute admission—days | 12.90 (14.19) | 7.36 (6.72) | 6.05 (−4.320 to 16.42) | p = 0.27 |
Rehabilitation admission—days | 17.90 (23.39) | 50.00 (42.92) | −29.85 (−54.269 to −5.431) | p = 0.03 * |
Out-patient sessions—hours | 28.50 (15.47) | 21.43 (21.79) | 6.75 (−7.17 to 20.67) | p = 0.36 |
Element | Usual Care Cohort (n = 10) | Robotics Cohort (n = 14) | Mean Difference (95%CI) | Significance |
---|---|---|---|---|
Pre-robotics total cost, AUD (SD) | ||||
Acute admission | AUD 27,151 (29,872) | AUD 15,485 (14,146) | AUD 11,666 (−10,523 to 33,856) | p = 0.27 |
Rehabilitation admission | AUD 20,126 (26,296) | AUD 56,218 (48,260) | –AUD 36,092 (−68,020 to −4164) | p = 0.03 * |
Out-patient sessions | AUD 2706 (1469) | AUD 2035 (2069) | AUD 672 (−826 to 2169) | p = 0.36 |
Total cost | AUD 49,984 (48,681) | AUD 73,378 (56,039) | –AUD 23,754 (−68,414 to 20,905) | p = 0.28 |
Program 1 | Program 2 | Program 3 | Program 4 | Program 5 | Program 6 | USUAL CARE | |
---|---|---|---|---|---|---|---|
Patient group time per program | 2040 | 2040 | 2040 | 2040 | 2040 | 2160 | 2430 |
Number of sessions per program | 17 | 17 | 17 | 17 | 17 | 18 | 18 |
Patients enrolled per program | 3 | 3 | 3 | 3 | 4 | 5 | 1 |
Patient session attendance (sessions) | 51 | 51 | 51 | 51 | 68 | 75 | 18 |
Patient session attendance (time) | 4590 | 4590 | 4590 | 4590 | 6120 | 6750 | 2430 |
STAFF SESSION ATTENDANCE | |||||||
Grade 1 | 18 | 20.5 | 16.25 | 0 | 10 | 8.25 | 0 |
Grade 2 | 0 | 0 | 0 | 0 | 6 | 5 | 18 |
Grade 3 | 17 | 16 | 13.75 | 19.5 | 16.75 | 9 | 0 |
AHA | 11 | 0 | 5 | 14.25 | 0 | 14.25 | 0 |
TOTAL STAFF SESSION ATTENDANCE | 46 | 36.5 | 35 | 33.75 | 32.75 | 36.5 | 18 |
STAFF ATTENDANCE IN MINUTES | |||||||
Grade 1 | 2160 | 2460 | 1950 | 0 | 1200 | 990 | 0 |
Grade 2 | 0 | 0 | 0 | 0 | 720 | 600 | 2430 |
Grade 3 | 2040 | 1920 | 1650 | 2340 | 2010 | 1080 | 0 |
AHA | 1320 | 0 | 600 | 1710 | 0 | 1710 | 0 |
TOTAL STAFF ATTENDANCE IN MINUTES | 5520 | 4380 | 4200 | 4050 | 3930 | 4380 | 2430 |
RATIO OF STAFF TO PATIENT TIME | 1.2 | 1.0 | 0.9 | 0.9 | 0.6 | 0.6 | 1.0 |
STAFF COST (S&W) FOR ATTENDANCE | |||||||
Grade 1 | AUD 1423 | AUD 1620 | AUD 1284 | – | AUD 790 | AUD 652 | – |
Grade 2 | – | – | – | – | AUD 569 | AUD 474 | AUD 1919 |
Grade 3 | AUD 1840 | AUD 1732 | AUD 1489 | AUD 2111 | AUD 1813 | AUD 974 | – |
AHA | AUD 746 | – | AUD 339 | AUD 967 | – | AUD 967 | – |
TOTAL STAFF COST (S&W) FOR ATTENDANCE | AUD 4010 | AUD 3352 | AUD 3112 | AUD 3078 | AUD 3172 | AUD 3067 | AUD 1919 |
TOTAL STAFF COST (S&W) PER PATIENT | AUD 1337 | AUD 1117 | AUD 1037 | AUD 1026 | AUD 793 | AUD 613 | AUD 1919 |
Week 1 | Week 2 | Week 3 | Week 4 | Week 5 | Week 6 | |
---|---|---|---|---|---|---|
Robotics weekly fee applied | 14 | 9 | 13 | 15 | 15 | 5 |
Fee excluded due to Early Supported Discharge program | 1 | 2 | 3 | 2 | 2 | 3 |
Fee excluded due to financial hardship or other reason | 5 | 9 | 4 | 3 | 3 | 12 |
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Brusco, N.; Voogt, A.; Nott, M.; Callaway, L.; Mansoubi, M.; Layton, N. Meeting Unmet Needs for Stroke Rehabilitation in Rural Public Health: Explorative Economic Evaluation of Upper Limb Robotics-Based Technologies through a Capabilities Lens. Societies 2022, 12, 143. https://doi.org/10.3390/soc12050143
Brusco N, Voogt A, Nott M, Callaway L, Mansoubi M, Layton N. Meeting Unmet Needs for Stroke Rehabilitation in Rural Public Health: Explorative Economic Evaluation of Upper Limb Robotics-Based Technologies through a Capabilities Lens. Societies. 2022; 12(5):143. https://doi.org/10.3390/soc12050143
Chicago/Turabian StyleBrusco, Natasha, Andrea Voogt, Melissa Nott, Libby Callaway, Mae Mansoubi, and Natasha Layton. 2022. "Meeting Unmet Needs for Stroke Rehabilitation in Rural Public Health: Explorative Economic Evaluation of Upper Limb Robotics-Based Technologies through a Capabilities Lens" Societies 12, no. 5: 143. https://doi.org/10.3390/soc12050143