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

Autor:	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)., Rose ML; School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia.; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia., Pierce JE; School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia.; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia., Nickels L; School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia (L.N.)., 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)., Togher L; Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia (L.T.)., Godecke E; Edith Cowan University, Joondalup, Western Australia (E.G.)., Meinzer M; Department of Neurology, University Medicine Greifswald, Germany (M.M.)., Rai T; University of Technology Sydney, New South Wales, Australia (T.R.)., Hurley M; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia., Foster A; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia.; Monash Health, Clayton, Victoria, Australia (A.F.).; School of Primary & Allied Health Care, Monash University, Frankston, Victoria, Australia (A.F.)., Carragher M; School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia.; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia., Wilcox C; School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia.; Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia., 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 (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2024 Mar; Vol. 55 (3), pp. 705-714. Date of Electronic Publication: 2024 Feb 08.
DOI:	10.1161/STROKEAHA.123.045183
Abstrakt:	Background: 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: 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: 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: 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. Competing Interests: Disclosures Drs Kim and Cadilhac report an educational grant from Moleac unrelated to this work paid to their institution. Dr Cadilhac reports education grant from Boehringer Ingelheim and Amazon Web Services unrelated to this work paid to her institution. Dr Godecke reports service as President for Aphasia WA
Databáze:	MEDLINE
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