Cost consequences analysis of early vocational rehabilitation compared with usual care for stroke survivors

Objective

To compare costs and consequences of Early Stroke Specialist Vocational Rehabilitation (ESSVR) with usual care in working age, stroke survivors over 12 months.

Design

An economic evaluation nested within the pragmatic, multi-centre, randomised, controlled RETurn to work After stroKE (RETAKE) study.

Setting

Twenty-one English and Welsh National Health Service (NHS) hospital-based stroke units. A UK NHS and Personal Social Services perspective was taken in the base-case and a wider perspective (participant, family, employer and other public services) in a secondary analysis.

Participants

A total of 583 stroke survivors age ≥18 years (mean 54.0 years, 69% male).

Interventions

Participants were randomised to ESSVR, an early, individually tailored (in content, dose, intensity and duration) intervention, plus usual care or usual care alone.

Main measures

Disease-specific resource-use data and EQ-5D-5L (health-related quality of life) collected at baseline, 3, 6 and 12 months. Resource-use items were valued using unit costs in UK£ 2021/22. EQ-5D-5L was used to estimate Quality-adjusted life-years (QALYs). If ESSVR was found effective, an incremental cost-utility analysis was planned, otherwise a cost-consequence analysis.

Results

The clinical study found no evidence of a between-group difference in the proportion of participants returning to work at 12 months. This, and the level of missing data, means a cost-consequence analysis is reported. Using imputed data, ESSVR plus usual care is estimated to be more expensive with slightly higher QALYs compared with usual care.

Conclusions

Early Stroke Specialist Vocational Rehabilitation is unlikely to be considered cost-effective over 12 months, which fits with the clinical finding of no between-group difference in return-to-work rates post-stroke.

Clinical trial registration information

The ISRCTN registry: ISRCTN12464275 https://doi.org/10.1186/ISRCTN12464275