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Clin Rehabil. 2015 Jan;29(1):30-41. doi: 10.1177/0269215514537656. Epub 2014 Jun 18.

Cost analysis of the Communication and Low Mood (CALM) randomised trial of behavioural therapy for stroke patients with aphasia.

Author information

  • 1Swansea Centre for Health Economics, Swansea University, UK.
  • 2Division of Rehabilitation and Ageing, University of Nottingham, UK shirley.thomas@nottingham.ac.uk.
  • 3Division of Rehabilitation and Ageing, University of Nottingham, UK.

Abstract

OBJECTIVE:

To evaluate the cost effectiveness of a behavioural therapy intervention shown to be clinically effective in comparison with usual care for stroke patients with aphasia.

DESIGN:

Randomised controlled trial with comparison of costs and calculation of incremental cost effectiveness ratio.

SETTING:

Community.

PARTICIPANTS:

Participants identified as having low mood on either the Visual Analog Mood Scale sad item (≥50) or Stroke Aphasic Depression Questionnaire Hospital version 21 (SADQH21) (≥6) were recruited.

INTERVENTIONS:

Participants were randomly allocated to behavioural therapy or usual care using internet-based randomisation generated in advance of the study by a clinical trials unit.

MAIN MEASURES:

Outcomes were assessed at six months after randomisation, blind to group allocation. The costs were assessed from a service use questionnaire. Effectiveness was defined as the change in SADQH21 scores and a cost-effectiveness analysis was performed comparing the behavioural group with the usual care control group. The cost analysis was undertaken from the perspective of the UK NHS and Social Services.

RESULTS:

The greatest difference was in home help costs where there was a saving of £56.20 in the intervention group compared to an increase of £61.40 in the control group. At six months the SADQH21 score for the intervention group was 17.3 compared to the control group value of 20.4. This resulted in a mean increase of 0.7 in the control group, compared to a mean significant different decrease of 6 in the intervention group (P = 0.003). The Incremental Cost-Effectiveness Ratio indicated that the cost per point reduction on the SADQH21 was £263.

CONCLUSION:

Overall the behavioural therapy was found to improve mood and resulted in some encouraging savings in resource utilisation over the six months follow-up.

© The Author(s) 2014.

KEYWORDS:

Aphasia; clinical evaluation; cognitive impairment; economic evaluation; health status

[PubMed - indexed for MEDLINE]
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