High-Intensity Aphasia Therapy Is Cost-Effective in People With Poststroke Aphasia: Evidence From the COMPARE Trial.

aphasia health care cost language therapy rehabilitation speech stroke

Journal

Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266

Informations de publication

Date de publication:
08 Feb 2024
Historique:
medline: 8 2 2024
pubmed: 8 2 2024
entrez: 8 2 2024
Statut: aheadofprint

Résumé

Evidence from systematic reviews confirms that speech and language interventions for people with aphasia during the chronic phase after stroke (>6 months) improve word retrieval, functional communication, and communication-related quality of life. However, there is limited evidence of their cost-effectiveness. We aimed to estimate the cost per quality-adjusted life year gained from 2 speech and language therapies compared with usual care in people with aphasia during the chronic phase (median, 2.9 years) after stroke. A 3-arm, randomized controlled trial compared constraint-induced aphasia therapy plus (CIAT-Plus) and multimodality aphasia therapy (M-MAT) with usual care in 216 people with chronic aphasia. Participants were administered a standardized questionnaire before intervention and at 12 weeks after the 2-week intervention/control period to ascertain health service utilization, employment changes, and informal caregiver burden. Unit prices from Australian sources were used to estimate costs in 2020. Quality-adjusted life years were estimated using responses to the EuroQol-5 Dimension-3 Level questionnaire. To test uncertainty around the differences in costs and outcomes between groups, bootstrapping was used with the cohorts resampled 1000 times. Overall 201/216 participants were included (mean age, 63 years, 29% moderate or severe aphasia, 61 usual care, 70 CIAT-Plus, 70 M-MAT). There were no statistically significant differences in mean total costs ($13 797 usual care, $17 478 CIAT-Plus, $11 113 M-MAT) and quality-adjusted life years (0.19 usual care, 0.20 CIAT-Plus, 0.20 M-MAT) between groups. In bootstrapped analysis of CIAT-Plus, 21.5% of iterations were likely to result in better outcomes and be cost saving (dominant) compared with usual care. In contrast, 72.4% of iterations were more favorable for M-MAT than usual care. We observed that both treatments, but especially M-MAT, may result in better outcomes at an acceptable additional cost, or potentially with cost savings. These findings are relevant in advocating for the use of these therapies for chronic aphasia after stroke.

Sections du résumé

BACKGROUND UNASSIGNED
Evidence from systematic reviews confirms that speech and language interventions for people with aphasia during the chronic phase after stroke (>6 months) improve word retrieval, functional communication, and communication-related quality of life. However, there is limited evidence of their cost-effectiveness. We aimed to estimate the cost per quality-adjusted life year gained from 2 speech and language therapies compared with usual care in people with aphasia during the chronic phase (median, 2.9 years) after stroke.
METHODS UNASSIGNED
A 3-arm, randomized controlled trial compared constraint-induced aphasia therapy plus (CIAT-Plus) and multimodality aphasia therapy (M-MAT) with usual care in 216 people with chronic aphasia. Participants were administered a standardized questionnaire before intervention and at 12 weeks after the 2-week intervention/control period to ascertain health service utilization, employment changes, and informal caregiver burden. Unit prices from Australian sources were used to estimate costs in 2020. Quality-adjusted life years were estimated using responses to the EuroQol-5 Dimension-3 Level questionnaire. To test uncertainty around the differences in costs and outcomes between groups, bootstrapping was used with the cohorts resampled 1000 times.
RESULTS UNASSIGNED
Overall 201/216 participants were included (mean age, 63 years, 29% moderate or severe aphasia, 61 usual care, 70 CIAT-Plus, 70 M-MAT). There were no statistically significant differences in mean total costs ($13 797 usual care, $17 478 CIAT-Plus, $11 113 M-MAT) and quality-adjusted life years (0.19 usual care, 0.20 CIAT-Plus, 0.20 M-MAT) between groups. In bootstrapped analysis of CIAT-Plus, 21.5% of iterations were likely to result in better outcomes and be cost saving (dominant) compared with usual care. In contrast, 72.4% of iterations were more favorable for M-MAT than usual care.
CONCLUSIONS UNASSIGNED
We observed that both treatments, but especially M-MAT, may result in better outcomes at an acceptable additional cost, or potentially with cost savings. These findings are relevant in advocating for the use of these therapies for chronic aphasia after stroke.

Identifiants

DOI: 10.1161/STROKEAHA.123.045183 PMID: 38328930
pubmed: 38328930
doi: 10.1161/STROKEAHA.123.045183
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Auteurs

Joosup Kim (J)

Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia (J.K., D.A. Cadilhac).
Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (J.K., D.A. Cadilhac).
ORCID: 0000-0002-4079-0428

Miranda L Rose (ML)

School of Allied Health, Human Services and Sport, Melbourne, Victoria, Australia. (M.L.R., J.E.P., A.M., M.C., C.W.).
Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia. (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac).
ORCID: 0000-0002-8892-0965

John E Pierce (JE)

School of Allied Health, Human Services and Sport, Melbourne, Victoria, Australia. (M.L.R., J.E.P., A.M., M.C., C.W.).
Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia. (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac).
ORCID: 0000-0001-5164-5106

Lyndsey Nickels (L)

School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia (L.N.).
ORCID: 0000-0002-0311-3524

David A Copland (DA)

Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia (D.A. Copland).
Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Australia (D.A. Copland).
ORCID: 0000-0002-2257-4270

Leanne Togher (L)

Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia (L.T.).
ORCID: 0000-0002-4518-6748

Erin Godecke (E)

Edith Cowan University, Joondalup, Western Australia (E.G.).
ORCID: 0000-0002-7210-1295

Marcus Meinzer (M)

Department of Neurology, University Medicine Greifswald, Germany (M.M.).

Tapan Rai (T)

University of Technology Sydney, New South Wales, Australia (T.R.).
ORCID: 0000-0003-1610-8983

Melanie Hurley (M)

Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia. (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac).
ORCID: 0000-0002-5400-2744

Abby Foster (A)

Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia. (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac).
Monash Health, Clayton, Victoria, Australia (A.F.).
School of Primary & Allied Health Care, Monash University, Frankston, Victoria, Australia (A.F.).
ORCID: 0000-0002-7787-8765

Marcella Carragher (M)

School of Allied Health, Human Services and Sport, Melbourne, Victoria, Australia. (M.L.R., J.E.P., A.M., M.C., C.W.).
Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia. (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac).
ORCID: 0000-0002-7200-6968

Cassie Wilcox (C)

School of Allied Health, Human Services and Sport, Melbourne, Victoria, Australia. (M.L.R., J.E.P., A.M., M.C., C.W.).
Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia. (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac).

Dominique A Cadilhac (DA)

Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia (J.K., D.A. Cadilhac).
Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (J.K., D.A. Cadilhac).
Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia. (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac).
ORCID: 0000-0001-8162-682X

Classifications MeSH