From the Veterans Administration Palo Alto Health Economics Resource Center & Department of Health Research and Policy (T.W.), Stanford University, Menlo Park, CA; Neurology Section (A.C.L.), Providence Veterans Administration Medical Center, and the Departments of Neurology, Community Health and Engineering, Brown University, Providence, RI; the Veterans Administration Connecticut Cooperative Studies Program Coordinating Center (P.P.), Yale School of Public Health, New Haven, CT; Indianapolis Veterans Administration Medical Center and Indiana University School of Medicine (D.M.B.), Indianapolis, IN; the Cooperative Studies Program Central Office (G.D.H.), Veterans Affairs Office of Research & Development, Washington, DC; Massachusetts Institute of Technology (H.I.K.), Mechanical Engineering Department, Cambridge, MA, and the University of Maryland School of Medicine, Department of Neurology, Baltimore, MD; the Veterans Affairs Cooperative Studies Program Clinical Research Pharmacy Coordinating Center (R.R.), University of New Mexico, Albuquerque, NM; the Department of Medicine (D.F.), Veterans Affairs Connecticut Healthcare System, West Haven, CT, and Yale University School of Medicine, New Haven, CT; North Florida/South Georgia Veterans Health System and Occupational Therapy Department (L.G.R.), University of Florida, Gainesville, FL; Veterans Affairs Puget Sound Health Care System (J.K.H.) and Rehabilitation Medicine and Epidemiology, University of Washington, Seattle, WA; Neurology (G.F.W.), Baltimore Veterans Affairs Medical Center, University of Maryland, Baltimore, MD; the Department of Neurology & Neuroscience (B.T.V.), Weill Medical College of Cornell University, White Plains, NY; Neurology and Research Services (C.T.B.), Veterans Affairs Maryland Health Care System and Departments of Neurology, Pharmacology and Physical Therapy, University of Maryland School of Medicine, Baltimore, MD; the Department of Community and Family Medicine (P.W.D.), Duke University, Durham, NC; Veterans Affairs Palo Alto Health Economics Resource Center (A.S.), Palo Alto, CA; and the Cooperative Studies Coordinating Center (P.G.), West Haven, CT.
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Background and Purpose—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.