In previous blog articles we have looked at the factors that impact the effectiveness of FES. For this article we are going to present a cost benefit analysis of Functional Electrical Stimulation when compared to traditional treatment.

Patient details

For this analysis we have used a patient that:

Is 40 years old
Has suffered a Spinal Cord Injury (SCI) following a fall down the stairs
Was diagnosed with a complete SCI at the level of T6
Was previously healthy
Had a BMI 24.5 pre-injury
Has a life expectancy of 69 years (Reyes and Molton, 2009)

Now, we need to consider what the common complications are of a person with a SCI. These include:

Respiratory
Cardiovascular
Urinary and bowel
Spasticity
Pain syndromes
Pressure ulcers
Osteoporosis and bone fractures

The two areas where there is strong evidence that FES can make an impact are spasticity and pressure ulcers (PU). So, let’s look at each of these in turn.

Spasticity

The most common management strategy for Spasticity is the use of Baclofen (either orally or intrathecally). Rushton, Lloyd and Anderson (2002) estimated cost for this treatment at £181,545.00 per annum for a cohort of 100 people. Calculating the lifetime cost for our case study is achieved as follows:

Years of treatment = Life expectancy – Age
= 69-40
= 29 years

Annual Cost of treatment per person = Annual cost of Treatment / cohort
= £181,545.00 / 100
= £1,815.45

Lifetime Cost of Spasticity Treatment = Annual Cost of treatment per person X Years of treatment
= £1,815.45 X 29
= £52,648.05

Pressure Ulcers (PU)

In 2004 the annual cost on managing PU in UK was £1.4–£2.1 billion (4% of total NHS budget) (Bennett, Dealey & Posnett, 2004), and it has been reported that patients with SCI are among the highest risk population for developing pressure ulcers, with an incidence of 25–66% (Kruger et al. 2013) and prevalence of 1.5 pressure ulcers per person per year (Scheel-Sailer et al., 2013).
In their comprehensive review of costs of managing PU, Bennet, Dealey and Posnett (2004) reported that the average cost of treating a single Grade II PU. was £4,402.00.

Calculating the potential lifetime cost of our case study is achieved as follows:

Annual Cost of treatment per person = Cost of Treatment * annual incidence
= £4,402.00 * 1.5
= £6,603.00

Lifetime Cost of PU Treatment = Annual cost of treatment per person * Years of treatment
= £6,603.00 * 29
= £191,487.00

Lifetime equipment costs for single case study

Calculations of cost of equipment are based upon the most popular of the Restorative Therapies’ Products, the RT300 SL, for stimulated leg therapy.

The retail cost of an RT300 SL is £14,995.00 which is expected to last for 8 years before requiring renewal.

The cost of electrodes is £50.00 per set. Recommended usage is 3 sessions per week, and manufacturer estimations of electrode lifetime is 15 applications.

Ongoing clinical and technical support and servicing costs are £1,200.00 per annum.

Lifetime cost for our case study is calculated as follows:

Lifetime cost of RT300 SL = Cost of RT300 SL * systems required
= £14,995.00 * (29/8)
= £14,995.00 * 4 (rounded up to complete units from 3.625)
= £59,980.00

Lifetime costs of electrodes = Cost per set * (((Sessions per week * weeks per year) * years of treatment) / sessions per set)
= £50 * (((3 * 52) * 29) / 15)
= £50 * 302 (rounded up to complete sets from 301.6)
= 15,100.00

Lifetime costs of support/servicing = Support/Service cost per year * Years of treatment
= £1,200.00 * 29
= £34,800.00

Lifetime costs of equipment = Lifetime cost of RT300 SL + Lifetime costs of electrodes + Lifetime costs of support/servicing
= £59,980.00 + £15,100.00 + £34,800.00
= £109,880.00

Cost-benefit (saving) for single case study

The potential healthcare saving, only taking into account elimination of Baclofen and prevention of pressure ulcers, may be calculated as follows:

Potential Lifetime Healthcare Saving = Lifetime Cost of Spasticity Treatment + Lifetime Cost of PU Treatment – Lifetime costs of equipment
= £52,648.05 + £191,487.00 – £109,880.00
= £134,255.05

Average saving per year = Potential Lifetime Healthcare Saving / Years of treatment
= £134,255.05 / 29
= £4,629.48

This article is taken from our white paper “The integration of Functional Electrical Stimulation (FES) technology and neurorehabilitation”.

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