Sarah Pyne, Tracey H Sach, Rory Cameron, Helen Risebro, Alexandra Wright-Hughes, Ellen Thompson, Dame Caroline Watkins, Audrey Bowen, Judith Stevens, Amanda J Farrin, Christopher McKevitt, John D Murray, Rory J O'Connor, Julie Phillips, Kate A Radford
{"title":"卒中幸存者早期职业康复与常规护理的成本后果分析。","authors":"Sarah Pyne, Tracey H Sach, Rory Cameron, Helen Risebro, Alexandra Wright-Hughes, Ellen Thompson, Dame Caroline Watkins, Audrey Bowen, Judith Stevens, Amanda J Farrin, Christopher McKevitt, John D Murray, Rory J O'Connor, Julie Phillips, Kate A Radford","doi":"10.1177/02692155241299372","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To compare costs and consequences of Early Stroke Specialist Vocational Rehabilitation (ESSVR) with usual care in working age, stroke survivors over 12 months.</p><p><strong>Design: </strong>An economic evaluation nested within the pragmatic, multi-centre, randomised, controlled RETurn to work After stroKE (RETAKE) study.</p><p><strong>Setting: </strong>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.</p><p><strong>Participants: </strong>A total of 583 stroke survivors age ≥18 years (mean 54.0 years, 69% male).</p><p><strong>Interventions: </strong>Participants were randomised to ESSVR, an early, individually tailored (in content, dose, intensity and duration) intervention, plus usual care or usual care alone.</p><p><strong>Main measures: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p><p><strong>Clinical trial registration information: </strong>The ISRCTN registry: ISRCTN12464275 https://doi.org/10.1186/ISRCTN12464275.</p>","PeriodicalId":10441,"journal":{"name":"Clinical Rehabilitation","volume":" ","pages":"2692155241299372"},"PeriodicalIF":2.6000,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Cost consequences analysis of early vocational rehabilitation compared with usual care for stroke survivors.\",\"authors\":\"Sarah Pyne, Tracey H Sach, Rory Cameron, Helen Risebro, Alexandra Wright-Hughes, Ellen Thompson, Dame Caroline Watkins, Audrey Bowen, Judith Stevens, Amanda J Farrin, Christopher McKevitt, John D Murray, Rory J O'Connor, Julie Phillips, Kate A Radford\",\"doi\":\"10.1177/02692155241299372\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To compare costs and consequences of Early Stroke Specialist Vocational Rehabilitation (ESSVR) with usual care in working age, stroke survivors over 12 months.</p><p><strong>Design: </strong>An economic evaluation nested within the pragmatic, multi-centre, randomised, controlled RETurn to work After stroKE (RETAKE) study.</p><p><strong>Setting: </strong>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.</p><p><strong>Participants: </strong>A total of 583 stroke survivors age ≥18 years (mean 54.0 years, 69% male).</p><p><strong>Interventions: </strong>Participants were randomised to ESSVR, an early, individually tailored (in content, dose, intensity and duration) intervention, plus usual care or usual care alone.</p><p><strong>Main measures: </strong>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.</p><p><strong>Results: </strong>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. 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Cost consequences analysis of early vocational rehabilitation compared with usual care for stroke survivors.
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.
期刊介绍：
Clinical Rehabilitation covering the whole field of disability and rehabilitation, this peer-reviewed journal publishes research and discussion articles and acts as a forum for the international dissemination and exchange of information amongst the large number of professionals involved in rehabilitation. This journal is a member of the Committee on Publication Ethics (COPE)
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