Marginal assessment of the cost and benefits of aphasia treatment: Evidence from community-based telerehabilitation treatment for aphasia

Abstract

Introduction Few studies have reported information related to the cost-effectiveness of traditional face-to-face treatments for aphasia. The emergence and demand for telepractice approaches to aphasia treatment has resulted in an urgent need to understand the costs and cost-benefits of this approach. Methods Eighteen stroke survivors with aphasia completed community-based aphasia telerehabilitation treatment, utilizing the Language-Oriented Treatment (LOT) delivered via Webex videoconferencing program. Marginal benefits to treatment were calculated as the change in Western Aphasia Battery-Revised (WAB-R) score pre- and post-treatment and marginal cost of treatment was calculated as the relationship between change in WAB-R aphasia quotient (AQ) and the average cost per treatment. Controlling for demographic variables, Bayesian estimation evaluated the primary contributors to WAB-R change and assessed cost-effectiveness of treatment by aphasia type. Results Thirteen out of 18 participants experienced significant improvement in WAB-R AQ following telerehabilitation delivered therapy. Compared to anomic aphasia (reference group), those with conduction aphasia had relatively similar levels of improvement whereas those with Broca’s aphasia had smaller improvement. Those with global aphasia had the largest improvement. Each one-point of improvement cost between US$89 and US$864 for those who improved (mean = US$200) depending on aphasia type/severity. Discussion Individuals with severe aphasia may have the greatest gains per unit cost from treatment. Both improvement magnitude and the cost per unit of improvement were driven by aphasia type, severity and race. Economies of scale to aphasia treatment–cost may be minimized by treating a variety of types of aphasia at various levels of severity.

Estimating the cost and value of functional changes in communication ability following telepractice treatment for aphasia

“…The framework utilized herein provides what the authors feel is an accurate and logical methodology for evaluating this data and associated cost framework. Furthermore, these findings do agree with other treatment valuation studies that show greater improvements and lower costs per unit of aphasia impairment among individuals with the most severe aphasias [12].…”

“…Although an emerging literature exists related to cost and cost-effectiveness of treatments for aphasia using measures of impairment [8,[10][11][12][13], little is known about the cost and costeffectiveness of improving functional communication in aphasia. As a comparison, our previous work showed that on average a one-point improvement in impairment as measured by the WAB-R AQ costs approximately $200 [12]. In contrast, a one level change in functional communication cost approximately $1100 for improvements in verbal expression or auditory comprehension.…”

“…Study participants were 20 PWA recruited a part of a telerehabilitation study for aphasia. The clinical details of the study participants and information related to the aphasia telerehabilitation treatment approach were previously published [12]. In brief summary, study participants were recruited from the eastern region of North Carolina (NC).…”

“…Similarly, Wenke et al found that computer-based and group treatment was 30% cheaper than standard service [11]. Finally, Jacobs and colleagues examined the cost-benefit of telepractice treatment for aphasia and found that each one-point reduction in impairment cost between approximately US $200 for those who improved and cost-benefit figures were influenced by aphasia type/severity with the lowest costs per reduction of impairment being observed by those with the most severe aphasia [12].…”

COVID-19 and Aphasia

“…Some examples include PWA being anxious about this new and strange remote setting of therapy delivery, their difficulties to pay attention to and stay on tasks virtually due to screen fatigue [29,30,31•], technical difficulties they could encounter as navigating a novel platform of presentation of therapy items, and barriers to accessibility to internet and technology [32]. Although the cost-effectiveness [33,34] and usefulness and efficiency of telepractice in chronic PWA have been reported (for example in terms of PWA's improvements in overall impairment levels and functional communication [34,35], enhanced naming performance [36], positive changes in PWA's conversation through training communication partners [37], and PWA's increased engagement in communicative activities and communication-related quality of life [38]), one should not neglect the factors that determine the suitability and candidacy of PWA to receive online intervention. These factors include type and characteristics of the treatment involved; feasibility for PWA to engage in real-time synchronous therapy versus asynchronous self-mediated practice via telerehabilitation; PWA's endurance and tolerance level of high versus low intensity of training; and the unique inherent perceptual, cognitive, and/or psychomotor barriers in PWA secondary to stroke or brain damage [39].…”