An economic evaluation alongside a randomised controlled trial of Scanning Eye trAining as a Rehabilitation Choice compared to sham training for Hemianopia after stroke (the SEARCH trial)
Fiona J Rowe, Jacob Davies, Kodchawan Doungsong, Ella Brayshaw, Michaela Brown, Kausik Chatterjee, Avril Drummond, Christine Hazelton, Brin Helliwell, Lauren R Hepworth, Claire Howard, Stevie Johnson, Carmel Noonan, Catherine Sackley, Laura Wright, Rhiannon Tudor EdwardsObjective
To explore the cost-effectiveness of visual scanning training for hemianopia compared to sham training.
Design
Randomised controlled trial.
Setting
Acute stroke unit and outpatient eye clinics.
Participants
Adult stroke survivors with homonymous hemianopia.
Intervention
Visual scanning training.
Comparator
Sham eye pursuit movements.
Main measures
Cost-utility and cost-effectiveness analyses were conducted from UK National Health Service (NHS) and wider societal perspectives. The primary analysis was a cost-utility analysis using EQ-5D-5L utility values. Cost-effectiveness analyses using changes in National Eye Institute-Visual Function Questionnaire-25 item composite and Brain Injury-associated Visual Impairment-Impact Questionnaire scores formed the secondary analyses.
Results
Both intervention and sham training packages cost £9.58 (printing costs, clinician time to explain self-administration). Mean total health resource use costs at 26-weeks were higher in the intervention (£1406) than in the sham group (£1339). At 26-weeks, the intervention group gained 0.001 (95%CI:-0.018, 0.021) Quality-Adjusted Life Years (QALY) while the sham group evidenced a QALY loss of −0.002 (95%CI:-0.017, 0.012); not statistically significant (p = 0.71). The Incremental Cost-Effectiveness Ratio of visual scanning training compared to sham was £19,790/QALY, below the National Institute for Health and Care Excellence (NICE) threshold of £20,000–£30,000/QALY. Sensitivity analysis (5000 replications) suggested potential cost-effectiveness of visual scanning training, which had a 67% probability of being cost-effective at £20,000/QALY; this was not significant.
Conclusions
This is the first economic evaluation comparing visual scanning training to sham training for treating post-stroke hemianopia. While both interventions had similar costs, the costs were slightly under NICE thresholds. The intervention evidenced marginal but non-significant QALY gain over sham.