High-Intensity Aphasia Therapy Is Cost-Effective in People With Poststroke Aphasia: Evidence From the COMPARE Trial

Joosup Kim; Miranda L Rose; John E Pierce; Lyndsey Nickels; David A Copland; Leanne Togher; Erin Godecke; Marcus Meinzer; Tapan Rai; Melanie Hurley; Abby Foster; Marcella Carragher; Cassie Wilcox; Dominique A Cadilhac

doi:10.1161/STROKEAHA.123.045183

High-Intensity Aphasia Therapy Is Cost-Effective in People With Poststroke Aphasia: Evidence From the COMPARE Trial

Stroke. 2024 Mar;55(3):705-714. doi: 10.1161/STROKEAHA.123.045183. Epub 2024 Feb 8.

Authors

Joosup Kim^{1

2}, Miranda L Rose^{3

4}, John E Pierce^{3

4}, Lyndsey Nickels⁵, David A Copland^{6

7}, Leanne Togher⁸, Erin Godecke⁹, Marcus Meinzer¹⁰, Tapan Rai¹¹, Melanie Hurley⁴, Abby Foster^{4

12

13}, Marcella Carragher^{3

4}, Cassie Wilcox^{3

4}, Dominique A Cadilhac^{1

2

4}

Affiliations

¹ Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia (J.K., D.A. Cadilhac).
² Stroke Division, Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (J.K., D.A. Cadilhac).
³ School of Allied Health, Human Services and Sport (M.L.R., J.E.P., A.M., M.C., C.W.), Melbourne, Victoria, Australia.
⁴ Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University (M.L.R., J.E.P., M.H., A.F., M.C., C.W., D.A. Cadilhac), Melbourne, Victoria, Australia.
⁵ School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia (L.N.).
⁶ Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia (D.A. Copland).
⁷ Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, Australia (D.A. Copland).
⁸ Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia (L.T.).
⁹ Edith Cowan University, Joondalup, Western Australia (E.G.).
¹⁰ Department of Neurology, University Medicine Greifswald, Germany (M.M.).
¹¹ University of Technology Sydney, New South Wales, Australia (T.R.).
¹² Monash Health, Clayton, Victoria, Australia (A.F.).
¹³ School of Primary & Allied Health Care, Monash University, Frankston, Victoria, Australia (A.F.).

PMID: 38328930
DOI: 10.1161/STROKEAHA.123.045183

Abstract

Background: Evidence from systematic reviews confirms that speech and language interventions for people with aphasia during the chronic phase after stroke (>6 months) improve word retrieval, functional communication, and communication-related quality of life. However, there is limited evidence of their cost-effectiveness. We aimed to estimate the cost per quality-adjusted life year gained from 2 speech and language therapies compared with usual care in people with aphasia during the chronic phase (median, 2.9 years) after stroke.

Methods: A 3-arm, randomized controlled trial compared constraint-induced aphasia therapy plus (CIAT-Plus) and multimodality aphasia therapy (M-MAT) with usual care in 216 people with chronic aphasia. Participants were administered a standardized questionnaire before intervention and at 12 weeks after the 2-week intervention/control period to ascertain health service utilization, employment changes, and informal caregiver burden. Unit prices from Australian sources were used to estimate costs in 2020. Quality-adjusted life years were estimated using responses to the EuroQol-5 Dimension-3 Level questionnaire. To test uncertainty around the differences in costs and outcomes between groups, bootstrapping was used with the cohorts resampled 1000 times.

Results: Overall 201/216 participants were included (mean age, 63 years, 29% moderate or severe aphasia, 61 usual care, 70 CIAT-Plus, 70 M-MAT). There were no statistically significant differences in mean total costs ($13 797 usual care, $17 478 CIAT-Plus, $11 113 M-MAT) and quality-adjusted life years (0.19 usual care, 0.20 CIAT-Plus, 0.20 M-MAT) between groups. In bootstrapped analysis of CIAT-Plus, 21.5% of iterations were likely to result in better outcomes and be cost saving (dominant) compared with usual care. In contrast, 72.4% of iterations were more favorable for M-MAT than usual care.

Conclusions: We observed that both treatments, but especially M-MAT, may result in better outcomes at an acceptable additional cost, or potentially with cost savings. These findings are relevant in advocating for the use of these therapies for chronic aphasia after stroke.

Keywords: aphasia; health care cost; language therapy; rehabilitation; speech; stroke.

Publication types

Randomized Controlled Trial

MeSH terms

Aphasia* / etiology
Aphasia* / therapy
Australia
Cost-Benefit Analysis
Humans
Language Therapy
Middle Aged
Quality of Life
Stroke Rehabilitation*
Stroke* / complications
Stroke* / therapy
Treatment Outcome