Self-managed, computerised word finding therapy as an add-on to usual care for chronic aphasia post-stroke: An economic evaluation.
Nicholas R Latimer, Arjun Bhadhuri, Abualbishr Alshreef and 10 others
PMID 33233972WHAT IT FOUND
Computerised word finding therapy adds about £733 per patient but produced uncertain quality of life gains.
It was not clearly cost-effective for the whole group, though it looked better for those with mild or moderate word finding difficulties.
Key findings
01The base-case analysis found the cost per QALY gained was £42,686 compared to usual care alone, which is above the £20,000–£30,000 threshold typically used to define cost-effectiveness.
02Subgroup analyses showed the intervention was potentially cost-effective for patients with mild (ICER £22,371) and moderate (ICER £21,262) word finding difficulties, but was dominated (more costly and less effective) for those with severe difficulties.
03The main driver of cost was speech and language therapist time; halving these staff costs would have reduced the ICER to £26,153, bringing it within the cost-effective threshold for the whole group.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study relies on a model rather than observed long-term data; outcomes beyond 12 months were extrapolated based on assumptions. The measure of health-related quality of life (EQ-5D-5L) is a generic tool that may not capture the specific benefits of improved word finding or communication. The analysis assumed usual care costs were equal across groups, although there was a slight indication that the computerised therapy group received less usual speech and language therapy time. The cost-effectiveness results were highly uncertain and changed significantly depending on which algorithm was used to calculate utility scores from the EQ-5D data.
Declared interests
The project was funded by the National Institute for Health Research (NIHR) and the Tavistock Trust for Aphasia. One author (PE) holds a patent on the Therapy Outcomes Measures used in the trial and receives royalties from it.
The easy way to misread this
Do not conclude that computerised therapy is ineffective clinically. The trial showed significant improvements in word finding. The 'mixed' economic finding reflects that these specific word finding gains did not translate into measurable improvements in general health-related quality of life (QALYs) in this model, and that the cost of staff support was high relative to the small QALY gain.