The potential for ‘smart glasses’ to transform UK facial palsy therapy: A national budget analysis, Delphi valuation exercise, and economic modelling of cost-effectiveness. (Preprint)

Abstract

BACKGROUND Facial palsy is the most common single nerve disorder world-wide. Incidence rates are rising globally, with incomplete recovery producing long-term reductions in quality of life for one in three cases. Neuromuscular retraining (NMR) to restore balanced facial function is the most widely evaluated effective non-drug therapy. There are currently no estimates of the likely economic impact of telerehabilitation introduced into the facial NMR therapy pathway. OBJECTIVE To undertake an analysis of the economic burden associated with facial palsy in the UK. To model the cost-effectiveness of digital rehabilitation (tracking sensors in ‘smart specs’) added into the NMR therapy pathway. METHODS The national burden associated with facial palsy included all treatment costs and economic consequences of unresolved cases. Estimates were based on annual incidence, clinical treatment patterns, recovery profiles, and impact on health-related quality of life. The monetary value placed on different levels of clinical recovery (House-Brackmann (HB) grade) was identified in a national Delphi exercise. An economic model was developed to estimate the costs and benefits of telerehabilitation from a healthcare perspective, and to calculate the incremental cost-effectiveness ratio. RESULTS The direct healthcare cost of facial palsy treatment for all patients diagnosed each year in the UK is estimated at £86.3 million. Long-term morbidity costs associated with these cases total £351-£584 million. Inclusion of societal costs, such as changes in employment, increases this figure to over £1.27 billion. The value placed on recovery from HB grades 5 and 6 is >£19,400, and £8,600 for HB grades 3 and 4. The economic model predicts that telerehabilitation will reduce healthcare costs and improve outcomes; conservative estimates are £468 saving per patient and health gain of 0.14 HB grade. Implementation of telerehabilitation for patients with incomplete recovery is predicted to produce a national saving of up to £3.08 million in healthcare costs per cohort, with associated HB grade recovery valued at up to £17.8 million. Inclusion of wider societal impact (e.g. on employment) increases cost savings significantly. CONCLUSIONS Introduction of digital rehabilitation into facial palsy therapy is predicted to reduce costs and improve patient outcomes. Further trials with integral economic evaluations are now needed to establish cost-effectiveness in real-world settings. CLINICALTRIAL NA