The Potential for Smart Glasses to Transform Facial Palsy Therapy Globally: UK Budget Analysis, Delphi Outcomes Valuation Exercise, and Economic Modeling of Cost-Effectiveness

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Background: Facial palsy is the most common single nerve disorder worldwide. Incidence rates are rising globally, with incomplete recovery producing long-term reductions in quality of life for one in three cases. Facial neuromuscular retraining (fNMR) to restore balanced facial function is the most widely evaluated effective nondrug therapy. There are currently no estimates of the likely economic impact of introducing telerehabilitation into the fNMR therapy pathway. Objective: This study aims to undertake an analysis of the economic burden associated with facial palsy in the United Kingdom and model the cost-effectiveness of telerehabilitation (tracking sensors in smart glasses) in the fNMR therapy pathway. Methods: The national burden associated with facial palsy was estimated including 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 via a national Delphi exercise. An economic model was developed to estimate the costs and benefits of telerehabilitation from a health care perspective and to calculate incremental cost-effectiveness. Results: Direct health care costs of facial palsy treatment for all patients diagnosed each year in the United Kingdom are estimated to be £86.3 million (2020 and 2021 prices; a currency exchange rate of £1.36=US $1 is applicable). Long-term morbidity costs associated with these annual cases total £351 million to £584 million. The inclusion of societal costs, such as changes in employment, will increase this figure to over £1.27 billion. Clinical recovery from HB grades 5 and 6 is valued at >£19,400, and at £8600 for HB grades 3 and 4. Economic modeling predicts that telerehabilitation will reduce health care costs and improve outcomes, with conservative estimates indicating £468 savings per patient and a health gain of 0.14 in HB grade. If smart glasses were added to fNMR therapy for patients with incomplete recovery, this is predicted to save national health care costs of up to £3.08 million per annual cohort. The associated HB grade recovery is valued at up to £17.8 million. The inclusion of factors related to the wider societal impact (eg, on employment) will increase cost savings significantly. Conclusions: The introduction of telerehabilitation to support self-management as part of facial palsy therapy is predicted to reduce costs and improve patient outcomes, and will not require substantial early investment. Further trials with integral economic evaluations are now needed to establish cost-effectiveness in real-world settings of digitally supported fNMR early in recovery and in chronic cases.

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