Healthcare-related cost of oropharyngeal dysphagia and its complications pneumonia and malnutrition after stroke: a systematic review

Abstract

ObjectivesTo assess the healthcare costs associated with poststroke oropharyngeal dysphagia (OD) and its complications (malnutrition, dehydration, pneumonia and death).DesignSystematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations.Data sourcesMEDLINE, Embase and the National Health Service Economic Evaluation Database were searched up to 31 December 2019.ParticipantsPatients with poststroke.Primary outcome measuresThe costs associated to poststroke OD and its complications.Data analysisData were synthetised narratively, quality evaluation was done using an adaptation of Drummond’s checklist and Grading of Recommendations Assessment, Development and Evaluation recommendations were used to assess strength of evidence.ResultsA total of 166 articles were identified, of which 10 studies were included. The cost of OD during the hospitalisation was assessed in four studies. One prospective study showed an increase of US$6589 for patients requiring tube feeding. Two retrospective studies found higher costs for those patients who developed OD, (US$7329 vs US$5939) among patients with haemorrhagic stroke transferred to inpatient rehabilitation and an increase of €3000 (US$3950) and SFr14 000 (US$15 300) in hospitalisation costs. One study did not found OD as a predictor for total medical costs in the multivariate analysis. One retrospective study showed an increase of US$4510 during the first year after stroke for those patients with OD. For pneumonia, five retrospective studies showed an increase in hospitalisation costs after stroke of between US$1456 and US$27 633. One prospective study showed an increase in hospitalisation costs during 6 months after stroke in patients at high malnutrition risk. Strength of evidence was considered moderate for OD and pneumonia and low for malnutrition.ConclusionsThis systematic review shows moderate evidence towards higher costs for those patients who developed OD after stroke. The available literature is heterogeneous, and some important aspects have not been studied yet. Further studies are needed to define the specific cost of poststroke OD.PROSPERO registration numberCRD42018099977.

Economic evaluations of health care interventions in Oropharyngeal Dysphagia after Stroke: Protocol for a Systematic Review.

“…4 Some health economic data on the cost and on sanitary resource consumption of post-stroke OD and its main complications have also been reported. 5,19 This shows an independent increase in costs associated with OD after stroke during hospitalization that can increase exponentially with the development of its main complications (malnutrition and respiratory infections) during long-term followup. In a recent study, we found the 1-year cost of a post-stroke patient with OD, malnutrition and at least one episode of respiratory infection is 19,817.58 ± 13,724.83 vs. 7,242.8 ± 7,402.6 euros, the latter of a post-stroke patient without OD, clearly showing the economic burden of post-stroke OD from both the Hospital and the Health Care System Perspectives.…”

“…27,600 USD) based on studies performed in France, Switzerland, Argentina, Brazil, Taiwan and the United States. 5 Appropriate management and treatment of post-stroke OD is required to avoid clinical complications, improve patients' quality of life and to save healthcare resources. 3 Current treatment for post-stroke OD is not standardized and includes a series of strategies that can go from compensation measures, including uid thickening and texture-modi ed foods (classical treatment) 6 , to more innovative neurorehabilitation approaches including peripheral stimulation treatments (electrical and pharmacologic studies) and noninvasive brain stimulation techniques (NIBS).…”

“…7 On the other hand, new strategies are based on the recovery of swallowing function and include peripheral stimulation treatments (transcutaneous and intrapharyngeal electrical stimulation and pharmacological TRP stimulants) and central stimulation treatments such as chemical or electrical stimulation and transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS), respectively. 7,9,10 Although the application of an appropriate treatment for OD in post-stroke patients should be mandatory in the neurology wards and also during the follow-up due to the high clinical, psychological and economic impact of OD, 2,5,11,12 currently, the cost-effectiveness of the mentioned strategies is not well known. Thus, the aim of this study is to develop a protocol for a systematic review to assess and summarise the current evidence on the e ciency or cost-effectivenes of available healthcare interventions on the appropriate management of OD.…”

Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

“…Post-extubation dysphagia is a common complication in mixed intensive care units (ICUs), causing aspiration pneumonia, malnutrition, and dehydration, and increasing the length of hospital stay and mortality (1)(2)(3)(4)(5). The prevalence of postextubation dysphagia ranges from 3 to 62%, which leads to increased healthcare-related costs (6,7).…”

Effect of Transcutaneous Electrical Stimulation in Chronic Poststroke Patients with Oropharyngeal Dysphagia: 1-Year Results of a Randomized Controlled Trial

“…2 Chronic poststroke oropharyngeal dysphagia is associated to significantly higher economic costs. 4 Pathophysiology of CPSOD has been associated with (a) bi-hemispheric reduction of efferent pathway's excitability with loss of motor dominance 5,6 and (b) reduced pharyngeal sensitivity 7 with disrupted cortical conduction/integration of pharyngeal sensory inputs at stroke site. 8 These dysfunctions and the uncoupling between sensory/motor swallowing circuitry cause the slow oropharyngeal swallow response (OSR) in these patients.…”