Self-managed, computerised word finding therapy as an add-on to usual care for chronic aphasia post-stroke: An economic evaluation. (May 2021)

• Record Type: Journal Article
• Authors: Latimer, Nicholas R; Bhadhuri, Arjun; Alshreef, Abualbishr; Palmer, Rebecca; Cross, Elizabeth; Dimairo, Munyaradzi; Julious, Steven; Cooper, Cindy; Enderby, Pam; Brady, Marian C; Bowen, Audrey; Bradley, Ellen; Harrison, Madeleine
• Is Part Of: Clinical rehabilitation. Volume 35:Number 5(2021)
• Page Start: 703
• Page End: 717
• Publication Date: 2021-05
• Subjects: Aphasia -- speech therapy -- cost-effectiveness -- computer supported -- self-management; Cost-Effectiveness -- Health Services -- Rehabilitation -- Treatment; Medical rehabilitation -- Periodicals; 617.03
• DOI: 10.1177/0269215520975348
• Languages: English
• ISSNs: 0269-2155

Abstract

Objective: To examine the cost-effectiveness of self-managed computerised word finding therapy as an add-on to usual care for people with aphasia post-stroke. Design: Cost-effectiveness modelling over a life-time period, taking a UK National Health Service (NHS) and personal social service perspective. Setting: Based on the Big CACTUS randomised controlled trial, conducted in 21 UK NHS speech and language therapy departments. Participants: Big CACTUS included 278 people with long-standing aphasia post-stroke. Interventions: Computerised word finding therapy plus usual care; usual care alone; usual care plus attention control. Main measures: Incremental cost-effectiveness ratios (ICER) were calculated, comparing the cost per quality adjusted life year (QALY) gained for each intervention. Credible intervals (CrI) for costs and QALYs, and probabilities of cost-effectiveness, were obtained using probabilistic sensitivity analysis. Subgroup and scenario analyses investigated cost-effectiveness in different subsets of the population, and the sensitivity of results to key model inputs. Results: Adding computerised word finding therapy to usual care had an ICER of £42, 686 per QALY gained compared with usual care alone (incremental QALY gain: 0.02 per patient (95% CrI: −0.05 to 0.10); incremental costs: £732.73 per patient (95% CrI: £674.23 to £798.05)). ICERs for subgroups with mild or moderate word finding difficulties were £22, 371 and £21, 262 per QALY gained respectively. Conclusion: Computerised word finding therapy represents a low cost add-on to usual care, but QALY gains and estimates of cost-effectiveness are uncertain. Computerised therapy is more likely to be cost-effective for people with mild or moderate, as opposed to severe, word finding difficulties.