Two speech therapies appear effective, cost-effective for chronic aphasia after stroke
A recent Australian trial found that high-intensity aphasia therapy outperformed usual care and proved cost-effective due to improvements in patient outcomes, measured in quality-adjusted life-years.
Two treatments worked for chronic aphasia after stroke and had better outcomes than usual care at an acceptable additional cost, or potentially with cost savings, an Australian study found.
Researchers estimated the cost per quality-adjusted life year (QALY) gained from two speech and language therapies compared with usual care in people with aphasia after stroke using a three-arm randomized controlled trial. At median of 2.9 years, patients were randomized to constraint-induced aphasia therapy plus (CIAT-Plus), multimodality aphasia therapy (M-MAT), or usual care. Both CIAT-Plus and M-MAT are high-intensity interventions delivered in groups of two to three people. CIAT-Plus uses verbal and orthographic cueing delivered by a therapist, and M-MAT also includes multimodal tasks and cues such as drawing, gesturing, and writing. No trial therapy was used in the usual care group.
Participants completed a standardized questionnaire before intervention and at 12 weeks after the two-week intervention/control period to measure health service use, employment changes, and informal caregiver burden. Unit prices from Australian sources were used to estimate costs in 2020. Results were published Feb. 8 by Stroke.
Overall, 201 participants were included. Mean age was 63 years, and 29% had moderate or severe aphasia. There were no statistically significant differences in mean total costs ($13,797 for usual care, $17,478 for CIAT-Plus, and $11,113 for M-MAT) or in QALYs gained (0.19 with usual care, 0.20 with CIAT-Plus, and 0.20 with M-MAT). In a bootstrapped analysis of CIAT-Plus, 21.5% of iterations were likely to result in better outcomes and had cost savings (dominant) compared with usual care. For M-MAT, 72.4% of iterations were more favorable than usual care.
The cost of neurologists was significantly different between usual care and M-MAT, but there were no other significant differences in costs between the groups. The researchers noted that the greatest costs were related to outpatient rehabilitation (>$2,000 per participant per group) and informal care (>$5,000 per participant per group). "Overall, it appeared that M-MAT was more favorable than CIAT-Plus when compared with usual care in terms of costs and QALYs. … We hypothesize that M-MAT generally had lower costs relative to other groups due to improvements in outcomes, which in turn decreases the utilization of health services," the study authors wrote.
The study shows that both intensive aphasia therapies led to better outcomes, with CIAT-Plus having an acceptable additional cost compared with usual care and M-MAT potentially having cost savings, the researchers concluded. "Along with the findings of the clinical evaluation, these data will be important for advocating for the implementation of these therapies for patients with chronic aphasia after stroke," they wrote.