Cost-Effectiveness of High-intensity Training vs Conventional Therapy for Individuals With Subacute Stroke.
T George Hornby, Miriam R Rafferty, Daniel Pinto and 2 others
PMID 34228956WHAT IT FOUND
High-intensity walking cost $309 more than conventional therapy but produced significantly greater walking speed gains.
The cost per 0.1 m/s improvement was $155, with a greater than 90% probability of being cost-effective if clinics are willing to pay $300 for that speed gain.
Key findings
01High-intensity training resulted in significantly greater gains in self-selected walking speed compared to conventional therapy, with a 0.2 m/s difference in change.
02The incremental cost-effectiveness ratio for high-intensity training was $155 for every 0.1-m/s gain in walking speed, with a 95% confidence interval of $38 to $242.
03High-intensity training had a greater than 90% probability of being cost-effective if the willingness to pay was at least $300 per 0.1 m/s change in walking speed.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The analysis combined data from a randomized trial and a pilot cohort, which may affect the generalizability of the results. Costs were based on 2016 US salaries and did not include equipment or indirect costs, which may vary significantly by clinic and region. The sample size was small (44 participants), leading to wide confidence intervals in the cost-effectiveness estimates. The study focused on subacute stroke patients who could already walk with moderate assistance, so results may not apply to those with more severe mobility impairments.
Declared interests
The study was supported by the U.S. Government, Non-P.H.S. sources. No specific commercial conflicts of interest were reported in the provided text.
The easy way to misread this
Do not assume this cost-effectiveness applies to all patients or clinics. The analysis only included personnel costs based on 2016 salaries and excluded equipment costs, meaning the true financial impact could be higher in settings without existing high-intensity infrastructure. Additionally, the study population was limited to those with subacute stroke who could already walk with moderate assistance.