Cost effectiveness of Constraint-induced and Multimodality Aphasia Therapy compared to standard chronic post-stroke aphasia care.

Abstract

Background: The COMPARE randomised controlled trial (RCT), found that Constraint-induced Aphasia Therapy Plus (CIAT-Plus) and Multimodality Aphasia Therapy (M-MAT) improved word retrieval, functional communication, and quality of life when compared to Usual Care in people with aphasia in the chronic phase after stroke. Aim(s): To estimate the cost per quality adjusted life year (QALY) gained from CIAT-Plus and M-MAT compared to usual care. Method(s): Data collected over 26 weeks from the COMPARE RCT were used. Participants were administered standardised questionnaires to ascertain health service utilisation, employment changes, and informal caregiver burden. Unit prices from Australian sources were used to estimate costs in 2020 Australian dollars. QALYs were estimated using responses to the Euroqol-5D-3L questionnaire converted to a utility score using an Australian algorithm. Multiple imputation with chained equations and nearest neighbour matching was used for missing values. To test uncertainty around the differences in costs and outcomes between groups, bootstrapping was used for 1000 random resampling iterations. Result(s): There were 201 randomised participants included in the analysis (mean age was 63 years, 29% moderate or severe aphasia). Mean total costs were $13,047 for Usual Care, $16,591 for CIAT Plus, and $10,420 for M-MAT. There were no differences in healthcare costs, costs including employment changes and informal care, utilities and QALYs between groups with or without multiple imputation. In bootstrapped analysis of CIAT-Plus, 44.3% of iterations were likely to result in better outcomes and be cost saving (dominant) compared to Usual Care. M-MAT was more favourable when compared to Usual Care than CIAT-Plus, with 79.3% of iterations dominant. Conclusion(s): The aphasia treatments resulted in better outcomes at an acceptable additional cost, or potentially with cost savings. These data will be important for advocating implementation of these treatments for people with chronic aphasia after stroke.