A cost-effectiveness analysis of screening methods for dysphagia after stroke

Area of Science:

• Healthcare Economics
• Clinical Neurology
• Swallowing Disorders

Background:

• Dysphagia is a common complication after stroke, increasing the risk of aspiration pneumonia and mortality.
• Current screening methods include clinical bedside swallowing evaluations and videofluoroscopic swallowing studies (VFSS).
• The cost-effectiveness of different dysphagia screening strategies in the acute poststroke period requires thorough analysis.

Purpose of the Study:

• To conduct a cost-effectiveness analysis comparing VFSS, clinical bedside swallowing evaluation, and a combined approach for dysphagia screening in acute poststroke patients.
• To determine the most economically viable and effective strategy for identifying and managing poststroke dysphagia.

Main Methods:

• A decision-analysis model was developed using data from meta-analyses and clinical studies.
• The model incorporated direct medical costs associated with pneumonia.
• Effectiveness was measured in quality-adjusted life-years (QALYs) through incremental cost-effectiveness analysis.

Main Results:

• The videofluoroscopic swallowing study (VFSS) strategy was found to be more effective and less costly than clinical bedside swallowing evaluation or a combined approach.
• Key factors influencing the model included pneumonia risk reduction from dysphagia treatment, clinical evaluation effectiveness, baseline pneumonia probability, and VFSS cost.

Conclusions:

• VFSS is a cost-effective strategy for poststroke dysphagia screening, often leading to cost savings compared to other methods.
• Further research on dysphagia treatment effectiveness in preventing aspiration pneumonia and mortality is recommended to refine cost-effectiveness models.