Close menu


Sunderland Repository records the research produced by the University of Sunderland including practice-based research and theses.

Economic evaluation of robot-assisted training versus an enhanced upper limb therapy programme or usual care for patients with moderate or severe upper limb functional limitation due to stroke: results from the RATULS randomised controlled trial

Fernandez-Garcia, Cristina, Ternent, Laura, Homer, Tara Marie, Rodgers, Helen, Bosomworth, Helen, Shaw, Lisa, Aird, Lydia, Andole, Sreeman, Cohen, David L, Dawson, Jesse, Finch, Tracy, Ford, Gary A, Francis, Richard, Hogg, Steven, Hughes, Niall, Krebs, H I, Price, Christopher I, Turner, Duncan L, van Wijck, Frederike, Wilkes, Scott, Wilson, Nina and Vale, Luke (2021) Economic evaluation of robot-assisted training versus an enhanced upper limb therapy programme or usual care for patients with moderate or severe upper limb functional limitation due to stroke: results from the RATULS randomised controlled trial. BMJ Open, 11 (5). e042081. ISSN 2044-6055

Item Type: Article


Objective: To determine whether robot-assisted training is cost-effective compared with an enhanced upper limb therapy (EULT) programme or usual care. Design: Economic evaluation within a randomised controlled trial. Setting: Four National Health Service (NHS) centres in the UK: Queen’s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust; Northwick Park Hospital, London Northwest Healthcare NHS Trust; Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde; and North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust. Participants: 770 participants aged 18 years or older with moderate or severe upper limb functional limitation from first-ever stroke. Interventions: Participants randomised to one of three programmes provided over a 12-week period: robot-assisted training plus usual care; the EULT programme plus usual care or usual care. Main economic outcome measures: Mean healthcare resource use; costs to the NHS and personal social services in 2018 pounds; utility scores based on EQ-5D-5L responses and quality-adjusted life years (QALYs). Cost-effectiveness reported as incremental cost per QALY and cost-effectiveness acceptability curves. Results: At 6 months, on average usual care was the least costly option (£3785) followed by EULT (£4451) with robot-assisted training being the most costly (£5387). The mean difference in total costs between the usual care and robot-assisted training groups (£1601) was statistically significant (p<0.001). Mean QALYs were highest for the EULT group (0.23) but no evidence of a difference (p=0.995) was observed between the robot-assisted training (0.21) and usual care groups (0.21). The incremental cost per QALY at 6 months for participants randomised to EULT compared with usual care was £74 100. Cost-effectiveness acceptability curves showed that robot-assisted training was unlikely to be cost-effective and that EULT had a 19% chance of being cost-effective at the £20 000 willingness to pay (WTP) threshold. Usual care was most likely to be cost-effective at all the WTP values considered in the analysis. Conclusions: The cost-effectiveness analysis suggested that neither robot-assisted training nor EULT, as delivered in this trial, were likely to be cost-effective at any of the cost per QALY thresholds considered. Trial registration number: ISRCTN69371850.

[img] XML

Download (110kB)
13546.pdf - Published Version
Available under License Creative Commons Attribution.

Download (384kB) | Preview

More Information

Additional Information: ** Embargo end date: 24-05-2021 ** From BMJ via Jisc Publications Router ** History: received 25-06-2020; accepted 28-04-2021; ppub 05-2021; epub 24-05-2021. ** Licence for this article starting on 24-05-2021:
Uncontrolled Keywords: Health economics, 1506, 1701, stroke medicine, rehabilitation medicine, stroke, health economics
Related URLs:
SWORD Depositor: Publication Router
Depositing User: Publication Router


Item ID: 13546
Identification Number:
ISSN: 2044-6055
Official URL:

Users with ORCIDS

ORCID for Cristina Fernandez-Garcia: ORCID iD
ORCID for Scott Wilkes: ORCID iD
ORCID for Nina Wilson: ORCID iD

Catalogue record

Date Deposited: 22 Jun 2021 10:08
Last Modified: 22 Jun 2021 10:15


Author: Cristina Fernandez-Garcia ORCID iD
Author: Scott Wilkes ORCID iD
Author: Nina Wilson ORCID iD
Author: Laura Ternent
Author: Tara Marie Homer
Author: Helen Rodgers
Author: Helen Bosomworth
Author: Lisa Shaw
Author: Lydia Aird
Author: Sreeman Andole
Author: David L Cohen
Author: Jesse Dawson
Author: Tracy Finch
Author: Gary A Ford
Author: Richard Francis
Author: Steven Hogg
Author: Niall Hughes
Author: H I Krebs
Author: Christopher I Price
Author: Duncan L Turner
Author: Frederike van Wijck
Author: Luke Vale

University Divisions

Faculty of Health Sciences and Wellbeing > School of Nursing and Health Sciences

Actions (login required)

View Item View Item