Breaking down costs: rehabilitation robotics vs. usual care therapy in diverse healthcare models.

One of the significant barriers to the adoption of rehabilitation robotics into clinical care over the last 30 years has been the high investment costs of the technology. There have been limited efforts to understand the healthcare economics of implementing rehabilitation robotics compared to usual care. From the few studies that have investigated the cost, the findings have had limited generalizability to other clinical settings or contexts due to diverse healthcare models and the complexity of implementation factors. This study compares three organizational models in rehabilitation centers across the USA, UK, and Italy. We developed a common formula to compute cost differences between robotics and usual care for the upper limb and conducted a deterministic sensitivity analysis to identify key cost-influencing parameters. Results indicate that models where a single therapist supervises multiple patients can lead to significant economic savings: the Veteran Affairs in the US could achieve 18% savings with full utilization of robotic treatment slots (4300 h/year) and Italy's Fondazione don Gnocchi rehabilitation model could realize 30% savings (6187 h/year). Conversely, the organizational model adopted by the RATULS study in UK generates 105% additional costs with 1820 h/year of robotics usage, mainly due to the 1:1 therapist-patient ratio adopted.