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

Abstract

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

Metadata

Item Type:	Article
Authors/Creators:	Pyne, S. Sach, T.H. Cameron, R. Risebro, H. Wright-Hughes, A. https://orcid.org/0000-0001-8839-6756 Thompson, E. Watkins, D.C. Bowen, A. Stevens, J. Farrin, A.J. https://orcid.org/0000-0002-2876-0584 McKevitt, C. Murray, J.D. O'Connor, R.J. Phillips, J. Radford, K.A.
Copyright, Publisher and Additional Information:	© The Author(s) 2024. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
Keywords:	Stroke, rehabilitation, return to work, cost consequence, economic evaluation
Dates:	Published (online): 5 December 2024 Accepted: 23 October 2024
Institution:	The University of Leeds
Academic Units:	The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Inst of Clinical Trials Research (LICTR) (Leeds)
Depositing User:	Symplectic Publications
Date Deposited:	03 Feb 2025 13:46
Last Modified:	03 Feb 2025 13:46
Published Version:	https://journals.sagepub.com/doi/10.1177/026921552...
Status:	Published online
Publisher:	SAGE Publications
Identification Number:	10.1177/02692155241299372
Related URLs:	Author
Sustainable Development Goals:
Open Archives Initiative ID (OAI ID):	oai:eprints.whiterose.ac.uk:222767

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

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