Cost consequences analysis of early vocational rehabilitation compared with usual care for stroke survivors.
Sarah Pyne, Tracey H Sach, Rory Cameron and 12 others
PMID 39639534WHAT IT FOUND
Early specialist vocational rehabilitation cost more than usual care but produced only a tiny, non-significant gain in quality-adjusted life years.
The study's conclusion is highly uncertain because 85% of cost data was missing. Do not assume this proves the intervention is poor value.
Key findings
01The intervention group had slightly higher adjusted costs (£1282 difference) and slightly higher quality-adjusted life years (0.021 difference) compared to usual care, but neither difference was statistically significant.
02The economic evaluation is severely limited by missing data, with 85% of total cost data and 71% of quality-adjusted life year data missing in the complete case analysis.
03The authors concluded that the slight improvement in quality-adjusted life years is unlikely to justify the higher costs of the intervention over 12 months, but noted much uncertainty around this.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
Extremely high levels of missing data (85% for costs, 71% for QALYs) severely undermine the reliability of the economic findings. The analysis was restricted to a 12-month time horizon, which may miss long-term benefits of returning to work that can take years to materialise. The trial took place during the COVID-19 pandemic, which changed work norms and service use, limiting generalisability to post-pandemic contexts. The study population consisted largely of people with less severe strokes and higher return-to-work rates than anticipated, which may have reduced the potential impact of the intervention. Multiple comparisons were made without adjustment, increasing the chance of false-positive findings in secondary resource-use data.
Declared interests
The study was funded by the National Institute for Health and Care Research Health Technology Assessment programme. The funder had no role in the design, conduct, analysis, or reporting of the study. Two authors declared potential conflicts of interest related to advisory roles and committee memberships, but stated these did not influence the study.
The easy way to misread this
Do not interpret the finding that the intervention cost more and had negligible QALY gains as definitive proof that vocational rehabilitation is not cost-effective. The conclusion is based on a complete case analysis where 85% of cost data was missing, and the adjusted analysis showed high uncertainty. The study also had a short 12-month horizon and was conducted during the pandemic, both of which limit the ability to draw firm conclusions about long-term value.