4CPS-116 The efficiency and cost-effectiveness of healthcare and nutritional interventions in the management of post-stroke oropharyngeal dysphagia, results of a systematic review. Issue 1 (23rd March 2023)

• Record Type: Journal Article
• Authors: Marin, S; Ortega, O; Serra-Prat, M; Valls, E; Pérez-Cordón, L; Codina-Jiménez, C; Clavé, P
• Is Part Of: European journal of hospital pharmacy. Volume 30:Issue 1(2023)supplement 1
• Page Start: A61
• Page End: A61
• Publication Date: 2023-03-23
• Subjects: Pharmacy -- Periodicals; Hospital pharmacies -- Periodicals; 615.1
• DOI: 10.1136/ejhpharm-2023-eahp.128
• Languages: English
• ISSNs: 2047-9956

Abstract

Abstract : Background and Importance: Post-stroke oropharyngeal dysphagia (PS-OD) causes significant high costs during hospitalisation that increase with the development of malnutrition and respiratory infections at long-term. This data suggests that the appropriate management of PS-OD including the use of early detection programmes, texture-modified diets, commercially thickened fluids, domiciliary enteral nutrition, and rehabilitation programmes including restorative treatments could lead to cost-effective reduction of clinical complications. 1 Aim and Objectives: To assess literature on the efficiency and cost-effectiveness of available healthcare interventions on the management of PS-OD. Material and Methods: Systematic review following PRISMA recommendations. MEDLINE, Embase, NHS-EED and CEA-Registry were searched up to 30 June 2021 to include studies on PS-OD. Outcomes of interest were the efficiency and the cost-effectiveness of healthcare interventions on the management of PS-OD. Economic evaluation studies were included. Oesophageal dysphagia and non-stroke studies were excluded. Results: 235 studies were identified and 10 included. Svendsen- et-al found lower hospitalisation costs (HC) (USD12, 556 CI95% 9, 751-15, 361) when PS-OD was assessed during the first 24 hours after admission. Liu- et-al did not find differences in HC when PS-OD was assessed with the water swallowing vs volume-viscosity swallowing test if the water test failed. Schwartz- et-al found a non-significant reduction on HC (Australian dollars18, 053 vs 16, 548, p=0.722) using a protocol to manage OD after thrombolysis. Wilson et-al showed video fluoroscopy as the most cost-effective screening method compared to bedside evaluation and a combination of both. Khiaocharoen et-al and Suksathien et-al showed cost-effective rehabilitation programmes that included OD management. Pelczarska et-al showed that the use of texture-modified diets using a gum-based thickener (Nutilis Clear®) was cost-effective (PLN21, 387-20, 977 per QALY), and Kotecki et-al that commercially thickened fluids use was more efficient than in situ preparation. Elia et-al showed domiciliary enteral nutrition cost-effective (£12, 817 per QALY) and Beavan- et-al showed higher nutrient intake and low HC increase using looped-nasogastric tube (5, 20 sterling for every 1% increase). Conclusion and Relevance: Healthcare interventions to manage PS-OD with a positive clinical effect tend to be cost-effective. Future studies assessing the cost-effectiveness of applying compensatory and/or restorative strategies among with reporting cost-savings by appropriate PS-OD early evaluation and management are ne References: Marin S, et al. Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke: protocol for a systematic review. Syst Rev . 2022;11 (1): 92. Conflict of Interest: No conflict of interest