Economic evaluation of intensive hand rehabilitation in patients with recent traumatic tetraplegia

Background This thesis investigated the cost-effectiveness of an innovative 8-week intensive functional electrical stimulation (FES)-assisted hand therapy program for people with recent traumatic tetraplegia that was conducted alongside a pragmatic assessor-blinded phase 3 randomised controlled trial (‘SCIPA Hands On’) at seven sites across Australia and New Zealand, and the issues that emerged during the trial regarding its two multi-attribute utility instruments, Health Utility Index Mark 3 (HUI-3) and Assessment of Quality of Life-8 (AQoL-8). Methods The economic evaluation was an intention-to-treat cost-utility analysis from a third-party payer perspective over a six-month time horizon. Costs were expressed in Australian dollars (AU$); the price year was 2015. In-depth analyses of sample- and participant-level HUI-3 and AQoL-8 responses were undertaken from a subgroup of SCIPA Hands On participants with complete utility data (80% of total sample) to identify factors that may have affected the utility results. Results Irrespective of instrument, the probability of the SCIPA Hands On intervention being cost-effective was above 75% and 78% for willingness-to-pay thresholds of AU$50,000 and AU$100,000 per quality-adjusted life-year respectively. Exploratory sub-group analyses found that for the more severe AIS A or B motor complete injuries, the intervention’s cost-effectiveness probability was unlikely to be more than 55%; for less severe AIS C or D motor incomplete injuries however, it dominated standard care hand therapy alone. In-depth analyses of HUI-3 and AQoL-8 found that while there were significant improvements in some of the expected instrument attributes/items over time as hypothesised (HUI-3 dexterity and ambulation, AQoL-8 household tasks and mobility, but not family role) and significant associations between them and change in summary utility, there were some unexpected associations between change in HUI-3 summary utility and changes in HUI-3 emotion a