Department of Physical Therapy, College of Health Sciences, Marquette University, Milwaukee, USA.
World Health Organization Collaborating Center for the Epidemiology of Musculoskeletal Health and Aging, University of Liege, Liege, Belgium.
J Neuroeng Rehabil. 2023 Jan 21;20(1):10. doi: 10.1186/s12984-023-01134-7.
Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort.
A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves.
Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY.
The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.
目前，针对脊髓损伤（SCI）后运动训练策略的成本效益评估很少，如果有的话。本研究的目的是通过损伤状态（完全性与不完全性），利用基于实践的队列，来评估 SCI 后运动训练策略（地面机器人训练与传统运动训练）的成本效益。
通过来自四个参与脊髓损伤模型系统（Spinal Cord Injury Model System）站点的前瞻性基于实践的队列，进行概率性成本效益分析。传统运动训练策略（常规训练）与地面机器人运动训练（地面机器人训练）进行比较。传统运动训练包括带有体重支撑的跑步机训练、地面训练和固定机器人系统。使用 EQ-5D 计算质量调整生命年（QALYs）和治疗费用。我们使用增量成本效用比（incremental cost utility ratio）来评估成本效益，并在成本效益平面和成本效益接受曲线中呈现结果。
具有完整 EQ-5D 数据的前瞻性基于实践的队列中的参与者（n=99）符合分析条件。常规训练和地面机器人训练都能提高 QALYs。只有不完全性 SCI 患者接受常规运动训练后有改善，0.045（标准差 0.28），只有完全性 SCI 患者接受地面机器人训练后有改善，0.097（标准差 0.20）。常规训练的成本较低，1758 美元（标准差 1697 美元），地面机器人训练的成本较高，3952 美元（标准差 3989 美元），而且不完全性损伤的成本低于完全性损伤。对于不完全性 SCI 患者，常规地面训练比机器人治疗更有效且成本更低。对于完全性 SCI 患者，地面机器人训练比常规训练更有效且成本更高。对于完全性脊髓损伤患者，地面机器人训练的增量成本效用比为 12353 美元/QALY。
针对 SCI 患者的最具成本效益的运动训练策略因损伤完整性而异。对于不完全性 SCI 患者，常规训练比地面机器人训练更具成本效益。对于完全性 SCI 患者，地面机器人训练比常规训练更具成本效益。这些估计值可能受到小样本量和基于实践的证据方法的限制。这些估计值为未来的研究提供了基线。
