Author Identifier (ORCID)

Erin Godecke: https://orcid.org/0000-0002-7210-1295

Emily Louise Brogan: https://orcid.org/0000-0001-9604-4558

Elizabeth Armstrong: https://orcid.org/0000-0003-4469-1117

Natalie Ciccone: https://orcid.org/0000-0002-1822-7217

Abstract

Introduction: There is limited evidence on the costs and outcomes of patients with aphasia after stroke. The aim of this study was to estimate costs in patients with aphasia after stroke according to the aphasia therapies provided.

Methods: A three-arm, prospective, randomized, parallel group, open-label, blinded endpoint assessment trial conducted in Australia and New Zealand. Usual ward-based care (Usual Care) was compared to additional usual ward-based therapy (Usual Care Plus) and a prescribed and structured aphasia therapy program in addition to Usual Care (the VERSE intervention). Information about healthcare utilization and productivity were collected to estimate costs in Australian dollars for 2017–18. Multivariable regression models with bootstrapping were used to estimate differences in costs and outcomes (clinically meaningful change in aphasia severity measured by the WAB-R-AQ).

Results: Overall, 202/246 (82%) participants completed follow-up at 26 weeks. Median costs per person were $23,322 (Q1 5,367, Q3 52,669, n = 63) for Usual Care, $26,923 (Q1 7,303, Q3 76,174, n = 70) for Usual Care Plus and $31,143 (Q1 7,001. Q3 62,390, n = 69) for VERSE. No differences in costs and outcomes were detected between groups. Usual Care Plus was inferior (i.e. more costly and less effective) in 64% of iterations, and in 18% was less costly and less effective compared to Usual Care. VERSE was inferior in 65% of samples and less costly and less effective in 12% compared to Usual Care.

Conclusion: There was limited evidence that additional intensively delivered aphasia therapy within the context of usual acute care provided was worthwhile in terms of costs for the outcomes gained.

Keywords

aphasia, cost-effectiveness, economic evaluation, speech therapy, therapy dose

Document Type

Journal Article

Date of Publication

1-1-2023

Volume

31

Issue

2

PubMed ID

37415422

Publication Title

Topics in Stroke Rehabilitation

Publisher

Taylor & Francis

School

School of Medical and Health Sciences

RAS ID

61901

Funders

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Erin Godecke—National Health and Medical Research Council (NHMRC, Australia Funding: #1083010, #1132468, #1153236), Elizabeth Armstrong—NHMRC Funding: #1132468; Miranda L Rose—NHMRC Funding: #1083010, #1153236; Dominique A Cadilhac—NHMRC Funding #1063761, #1154273; Julie Bernhardt—NHMRC Funding—#1154904, #1058635. Erin Godecke reports support from the Tavistock Trust. Fiona Ellery reports personal fees from Florey Institute of Neurosciences and Mental Health, The University of Melbourne during the conduct of the study; Graham J Hankey has received honoraria from Bayer for lecturing at sponsored scientific symposia and consulting on advisory boards about stroke prevention in atrial fibrillation, unrelated to this study.

Grant Number

NHMRC Numbers : 1083010, 1132468, 1153236, 1063761, 1154273, 1154904, 1058635

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

Comments

Kim, J., Sookram, G., Godecke, E., Brogan, E., Armstrong, E., Ellery, F., Rai, T., Rose M.L., Ciccone, N., Middleton, S., Holland, A., Hankey, G.J., Bernhardt, J. & Cadilhac, D. A. (2024). Economic evaluation of the very early rehabilitation in speech (verse) intervention. Topics in Stroke Rehabilitation, 31(2), 157-166. https://doi.org/10.1080/10749357.2023.2229039

First Page

157

Last Page

166

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Link to publisher version (DOI)

10.1080/10749357.2023.2229039