Study estimated the cost-effectiveness of overground robotic locomotor training versus conventional locomotor training following spinal cord injury (SCI) by injury status (complete versus incomplete). A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating SCI Model System sites. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. Cost-effectiveness was estimated using the incremental cost utility ratio. Ninety-nine participants with complete EQ-5D data qualified for the analysis. Both groups experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, and only people with complete SCI improved with overground robotic training. Costs were lower for conventional training, versus overground robotic training, and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete SCI was $12,353 per QALY. Findings suggest that the most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology.
