Cost-effectiveness analysis of robotic exoskeleton versus conventional physiotherapy for stroke rehabilitation in Singapore from a health system perspective

Abstract

OBJECTIVES: This study conducted a comprehensive probabilistic cost-effectiveness analysis comparing robotic exoskeleton therapy to conventional physiotherapy for stroke rehabilitation in Singapore, focusing on three patient groups categorised by their Functional Ambulation Category (FAC) scores. DESIGN: A probabilistic cost-effectiveness analysis was conducted alongside a non-randomised controlled study. Costs and Quality-Adjusted Life Years (QALYs) for both interventions were calculated and compared over a 6 month period. SETTING: The study was carried out at Alexandra Hospital, Jurong Community Hospital and St Luke's Hospital in Singapore. PARTICIPANTS: Individuals requiring inpatient gait rehabilitation from acute to subacute stages of stroke recovery, with FAC scores of 0-1, were included in the analysis. PRIMARY OUTCOME MEASURE: The primary outcome measure was QALYs, a composite measure combining the length and quality of life into a single value. RESULTS: Robotic exoskeleton therapy was found to be cost-effective compared with conventional physiotherapy across all patient groups, with Group 2 (FAC 0) showing the most favourable cost-effectiveness profile (incremental cost-effectiveness ratio (ICER): US$ 28 259.62 per QALY gained). The probabilistic sensitivity analysis demonstrated the robustness of the results, with QALY gains and the cost of the robotic exoskeleton having the largest impact on the ICER. CONCLUSION: The findings suggest that robotic exoskeleton therapy is likely to be cost-effective for stroke rehabilitation in Singapore, particularly for patients with severe mobility impairments (FAC 0). The results have important implications for clinical practice, resource allocation and future research in the field of stroke rehabilitation in Singapore. TRIAL REGISTERATION NUMBER: NCT05659121.