Quality Adjusted Life Years (QALY) Gain From The Use Of FES For The Correction Of
Dropped Foot Due To Stroke And Multiple Sclerosis Derived Using The Eurool EQ-5L-5D
Paul. Taylor1, 2, 3, Tamsyn. Street1 and Ian. Swain2, 3
1Salisbury NHS Foundation Trust, Salisbury, 2Bournemouth University, Bournemouth, 3Odstock Medical Ltd, Salisbury,
FES is an effective intervention for dropped foot and has a mean usage of 4.9 years1. The National Institute for Health
and Clinical Excellence applies a cost-utility ceiling of £20,000 per Quality Adjusted Life Year (QALY) for an intervention
to be considered. Previously the QALY gain derived from the effect of FES on walking speed was estimated as 0.041,
giving a cost per QALY of £15,406. The aim of this study is to produce a new estimate of QALY gain using the Euroqol
45 people with MS (mean age 53, range 40-70) and 26 with stroke (mean age 59.5, range 44-72) who had foot drop
completed the EQ-5D-5L before and after using FES for 20 weeks. QALY gain was calculated by multiplying the change
in EQ-5D-5L utility score by the average FES use time, from the previous long term audit1, discounted at 3.5% per year.
The mean cost of FES provision1 was divided by the new QALY gain to give the mean cost per QALY.
The mean EQ-5D-5L derived utility value pre intervention was 0.542 for MS and 0.498 for stroke. This increased after 20
weeks of FES use to 0.656 for MS and 0.612 for stroke, providing a utility value of 0.114 for both conditions (MS
p<0.001, Stroke p<0.005). Justified by the observation that the mean increase in walking speed due to FES remains
steady throughout the time FES was used, the QALY gain was extrapolated over 4.9 years giving a total gain of 0.542.
From the long term audit the mean cost was £3095, giving a mean cost per QALY of £5,705.
Discussion and conclusions
The new value for QALY gain derived using an accepted health economic assessment indicates that original value
significantly under estimated the benefit of FES to health related quality of life.
1. Taylor P, Humphreys L, Swain I. The long-term cost-effectiveness of the use of Functional Electrical Stimulation for the correction
of dropped foot due to upper motor neuron lesion. J. Rehabil. Med. 2013;45:154-60.
Supported by the National Health Service (UK and OML
IFESS 2017, July 20th-22nd, London