title: An economic analysis of robot-assisted therapy for long-term upper-limb impairment after stroke.
abstract: OBJECTIVE
  Stroke is a leading cause of disability. Rehabilitation robotics have been developed to aid in recovery after a stroke. This study determined the additional cost of robot-assisted therapy and tested its cost-effectiveness.
  
  
  METHODS
  We estimated the intervention costs and tracked participants' healthcare costs. We collected quality of life using the Stroke Impact Scale and the Health Utilities Index. We analyzed the cost data at 36 weeks postrandomization using multivariate regression models controlling for site, presence of a prior stroke, and Veterans Affairs costs in the year before randomization.
  
  
  RESULTS
  A total of 127 participants were randomized to usual care plus robot therapy (n=49), usual care plus intensive comparison therapy (n=50), or usual care alone (n=28). The average cost of delivering robot therapy and intensive comparison therapy was $5152 and $7382, respectively (P<0.001), and both were significantly more expensive than usual care alone (no additional intervention costs). At 36 weeks postrandomization, the total costs were comparable for the 3 groups ($17 831 for robot therapy, $19 746 for intensive comparison therapy, and $19 098 for usual care). Changes in quality of life were modest and not statistically different.
  
  
  CONCLUSIONS
  The added cost of delivering robot or intensive comparison therapy was recuperated by lower healthcare use costs compared with those in the usual care group. However, uncertainty remains about the cost-effectiveness of robotic-assisted rehabilitation compared with traditional rehabilitation. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique identifier: NCT00372411.
authors.affiliation: VA Palo Alto Health Economics Resource Center & Department of Health Research and Policy, Stanford University, 795 Willow Road, 152-MPD, Menlo Park, CA 94025, USA. Todd.Wagner@va.gov
authors.forename: Todd H
authors.initials: TH
authors.lastname: Wagner
authors.forename: Albert C
authors.initials: AC
authors.lastname: Lo
authors.forename: Peter
authors.initials: P
authors.lastname: Peduzzi
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
authors.forename: Grant D
authors.initials: GD
authors.lastname: Huang
authors.forename: Hermano I
authors.initials: HI
authors.lastname: Krebs
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Ringer
authors.forename: Daniel G
authors.initials: DG
authors.lastname: Federman
authors.forename: Lorie G
authors.initials: LG
authors.lastname: Richards
authors.forename: Jodie K
authors.initials: JK
authors.lastname: Haselkorn
authors.forename: George F
authors.initials: GF
authors.lastname: Wittenberg
authors.forename: Bruce T
authors.initials: BT
authors.lastname: Volpe
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Bever
authors.forename: Pamela W
authors.initials: PW
authors.lastname: Duncan
authors.forename: Andrew
authors.initials: A
authors.lastname: Siroka
authors.forename: Peter D
authors.initials: PD
authors.lastname: Guarino
mesh_terms: D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D009069:Movement Disorders / Q000191:economics* / Q000209:etiology / Q000534:rehabilitation; D026741:Physical Therapy Modalities / Q000191:economics*; D011788:Quality of Life; D012371:Robotics / Q000191:economics* / Q000379:methods; D020521:Stroke / Q000150:complications / Q000191:economics*; D000071939:Stroke Rehabilitation; D014481:United States; D014493:United States Department of Veterans Affairs; D034941:Upper Extremity