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

Area of Science:

• Neurorehabilitation
• Health Economics
• Speech-Language Pathology

Background:

• Systematic reviews confirm speech and language interventions improve communication in chronic aphasia post-stroke.
• Limited evidence exists regarding the cost-effectiveness of these therapies.
• This study estimates the cost per quality-adjusted life year (QALY) for two therapies versus usual care.

Purpose of the Study:

• To estimate the cost-effectiveness of constraint-induced aphasia therapy plus (CIAT-Plus) and multimodality aphasia therapy (M-MAT) compared to usual care.
• To assess the cost per QALY gained in individuals with chronic aphasia post-stroke.
• To provide evidence for advocating the use of these therapies.

Main Methods:

• A 3-arm randomized controlled trial involving 216 participants with chronic aphasia.
• Comparison of CIAT-Plus and M-MAT against usual care.
• Bootstrapping analysis (1000 resamples) to assess uncertainty in costs and QALYs.

Main Results:

• No statistically significant differences in mean total costs or QALYs were observed between CIAT-Plus, M-MAT, and usual care.
• Bootstrapped analysis indicated CIAT-Plus was dominant (better outcomes, cost-saving) in 21.5% of iterations.
• M-MAT was found to be more favorable than usual care in 72.4% of bootstrapped iterations.

Conclusions:

• Both CIAT-Plus and M-MAT, particularly M-MAT, may lead to improved outcomes at an acceptable cost, or even cost savings.
• These findings support the use of M-MAT and CIAT-Plus for managing chronic aphasia after stroke.
• The study highlights the potential economic benefits of targeted speech and language therapies.