Cost-Effectiveness and Cost Utility Analysis of an eHealth Peer-Led Wheelchair Training Program Compared to the Existing Wheelchair Training Practice in Canadian Rehabilitation Centers: Economic Evaluation of a RCT

OBJECTIVES: Mobility is a fundamental and basic human right. In clinical settings manual wheelchairs (MWC) training is often inadequate. The ‘Training to Enhance Adaptation and Management for Wheelchair users’ (TEAM Wheels) is a newly developed e-health home training program aiming at enhancing function and independence for MWC users trained by a peer trainer. This study aims to describe the cost-effectiveness and cost-utility of the TEAM Wheels training program.

METHODS: An economic evaluation was conducted alongside the TEAM Wheels multisite RCT. Adult MWC users were included. Participants assigned in the intervention group received the material package and the TEAM Wheels Program. The TEAM Wheels training is delivered using the TEAM Wheels application. For 4 weeks the participant collaborated with a peer-trained to define personal goals. Thought videoconferences the peer trainer tailored the training to address those goals, gave instructions for safe training, oriented the participant to the eHealth training program, monitored participant progress online, and adapted the program based on their progress.

RESULTS: Fifty participants were recruited. Twenty-seven participants were allocated to the intervention group. The mean (SD) age of the participants was 50.1 (15.8) years. Most were females (65%) and most were with spinal cord injury (42%). The mean (SD) previous experience using MWC was 5.63 (9.20) years. Participants who completed the TEAM Wheels program experienced higher WhOM scores from baseline to follow-up (increased from 4.33 to 6.58; p<0.001). The incremental cost-effectiveness ratio (ICER) was estimated as $1 240 per WhOM score. Participants who completed the TEAM Wheels program experienced higher SF-36D scores from baseline to follow-up (increased from 0.636 to 0.682; p=0.039). The incremental cost-utility ratio (ICUR) was estimated as $35 431 per QALYs.

CONCLUSIONS: Policy makers and community organizations can use this information to guide funding decisions and delivery of the TEAM Wheels program for individuals using a manual wheelchair.