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Comparative Study
. 2025 Feb;39(2):161-173.
doi: 10.1177/02692155241299372. Epub 2024 Dec 5.

Cost consequences analysis of early vocational rehabilitation compared with usual care for stroke survivors

Sarah Pyne  1 , Tracey H Sach  1   2 , Rory Cameron  1   3 , Helen Risebro  1   3 , Alexandra Wright-Hughes  4 , Ellen Thompson  4 , Dame Caroline Watkins  5 , Audrey Bowen  6 , Judith Stevens  7 , Amanda J Farrin  4 , Christopher McKevitt  8 , John D Murray  7 , Rory J O'Connor  9 , Julie Phillips  10 , Kate A Radford  10 ; RETAKE research group *
Affiliations
Comparative Study

Cost consequences analysis of early vocational rehabilitation compared with usual care for stroke survivors

Sarah Pyne et al. Clin Rehabil. 2025 Feb.

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.

Keywords: Stroke; cost consequence; economic evaluation; rehabilitation; return to work.

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Conflict of interest statement

Declaration of conflicting interestsThe author declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: THS was a member of the HTA General Committee 01/08/2016–31/07/2017 and HTA Commissioning Committee 19/06/2017–31/12/2019 but played no part in the decision making for funding this study. KAR acted in an unpaid advisory role to NHS England in Stroke Vocational Rehabilitation toolkit development (following the trial intervention delivery period) and sat on the HTA Clinical Evaluation and Trials (CET) Board 2017–2021. The remaining author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

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