Economic Evaluation of early vocational rehabilitation compared with usual care for stroke survivors: RETurn to work After stroKe (RETAKE)

Pyne, Sarah; Sach, Tracey H; Cameron, Rory; Risebro, Helen; Wright-Hughes, Alexandra; Thompson, Ellen; Watkins, Caroline; Bowen, Audrey; Stevens, Judith; Farrin, Amanda J; McKevitt, Christopher; Murray, John D; O’Connor, Rory J; Phillips, Julie; Radford, Kate A

Abstract

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

Citation

Pyne, S., Sach, T. H., Cameron, R., Risebro, H., Wright-Hughes, A., Thompson, E., Watkins, C., Bowen, A., Stevens, J., Farrin, A. J., McKevitt, C., Murray, J. D., O’Connor, R. J., Phillips, J., & Radford, K. A. (2024). Economic Evaluation of early vocational rehabilitation compared with usual care for stroke survivors: RETurn to work After stroKe (RETAKE). Clinical Rehabilitation, https://doi.org/10.1177/02692155241299372

• Journal Article Type: Article
• Acceptance Date: Oct 23, 2024
• Online Publication Date: Dec 5, 2024
• Publication Date: Dec 5, 2024
• Deposit Date: Feb 19, 2025
• Publicly Available Date: Feb 21, 2025
• Journal: Clinical Rehabilitation
• Print ISSN: 0269-2155
• Electronic ISSN: 1477-0873
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1177/02692155241299372
• Public URL: https://nottingham-repository.worktribe.com/output/45595772
• Publisher URL: https://doi.org/10.1177/02692155241299372
• Additional Information: On behalf of the RETAKE research group