Budget impact analysis of robotic exoskeleton use for locomotor training following spinal cord injury in four SCI Model Systems.
Daniel Pinto, Mauricio Garnier, Jason Barbas and 9 others
PMID 31924224WHAT IT FOUND
Introducing robotic exoskeletons for 10% of locomotor training sessions in four rehabilitation facilities resulted in small annual savings, ranging from $649 to $4784.
However, increasing conventional overground training by 10% yielded greater savings than adding the exoskeleton.
Key findings
01In the base case scenario, providing robotic exoskeletons for 10% of locomotor training sessions decreased annual costs, with savings ranging from $649 to $4784 across the four facilities.
02The analysis showed that increasing conventional overground training by 10% resulted in greater savings than shifting market share to robotic exoskeletons.
03The economic model assumed non-inferiority of robotic exoskeletons compared to conventional therapies, despite a lack of strong evidence for their superiority or non-inferiority.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study did not account for differences in clinical effectiveness between robotic exoskeletons and conventional therapies, assuming non-inferiority despite limited evidence. The analysis relied on assumptions about adoption rates and device idle time that may not reflect real-world clinical usage. It did not quantify potential reputational benefits for hospitals or the long-term community mobility benefits of exoskeletons. The model assumed that all other rehabilitative services remained unchanged, isolating the impact solely on locomotor training resources.
Declared interests
The study was funded by the National Institute on Disability, Independent Living, and Rehabilitation Research.
The easy way to misread this
Do not interpret the small base-case savings as evidence that robotic exoskeletons are cost-effective in all settings. The results were highly sensitive to adoption rates; if clinicians use the device infrequently, the costs increase substantially, making conventional overground training the more economical choice.