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

Abstract

Context Aphasia is a post-stroke condition that can dramatically impact a person with aphasia’s (PWA) communication abilities. To date, few if any studies have considered the cost and cost-effectiveness of functional change in aphasia nor considered measures of patient’s value for aphasia treatment. Objective To assess the cost, cost-effectiveness, and perceived value associated with improved functional communication in individuals receiving telerehabilitation treatment for aphasia. Design Twenty PWA completed between 5 and 12 telehealth rehabilitation sessions of 45–60 minutes within a 6-week time frame using a Language-Oriented Treatment (LOT) designed to address a range of language issues among individuals with aphasia. National Outcomes Measures (NOMS) comprehension and verbal expression and the ASHA Quality of Communication Life (QCL) were completed prior to and at the completion of rehabilitation to obtain baseline and treatment measures. Results Age, education, and race are significantly correlated with improvement in the NOMS verbal expression. African Americans (OR = 2.0917) are twice as likely as Whites to experience improvement after treatment. The likelihood of improvement also increases with each additional year of education (OR = 1.002) but decrease with age (OR = 0.9463). A total of 15 PWA showed improvement in NOMS comprehension and nine patients showed improvement in NOMS verbal expression. Improving patients attended between five and 12 treatment sessions. The average cost of improvement in NOMS comprehension was $1,152 per patient and NOMS verbal expression was $1,128 per patient with individual treatment costs varying between $540 and $1,296. However, on average, the monetary equivalent in patient’s improved QCL was between $1,790.39 to $3,912,54—far exceeding the financial cost of treatment. Conclusions When measuring the functional improvement of patients with aphasia, patient’s quality of communication life received from treatment exceeded financial cost of services provided.

Stroke Care Costs and Cost-Effectiveness to Inform Health Policy

“…The COVID-19 pandemic has underscored the need for greater telehealth use across the continuum of stroke care. Economic evaluations to guide policy are emerging for the telepractice treatment for aphasia 20 and other forms of telerehabilitation, 21 but more research is needed and particularly for low- and middle-income countries.…”

The Rationale for Economic Evaluation in Speech and Language: Cost, Effectiveness, and Cost-effectiveness

“…For example, Jacobs and Ellis studied telehealth rehabilitation sessions of 45 to 60 minutes within a 6-week time frame using a language-oriented treatment (LOT). 11 The researchers used the National Outcomes Measurement System (NOMS) 12 to measure change in functional communication and the American Speech Language and Hearing Association Quality of Communication Life Scale (ASHA QCL) 13 to measure quality of communication outcomes. Compared with an option that had no cost and no effect, individuals with aphasia receiving LOT experienced improvements in functional communication and quality of communication life.…”

Understanding the Economics of Aphasia: Recent Findings from Speech and Language Research

“…Utilizing the same aphasia telerehabilitation data, Jacobs and Ellis also calculated the cost and value of functional communication change among PWA. 29 National Outcomes Measurement System (NOMS) comprehension and verbal expression were completed prior to and at the completion of aphasia telerehabilitation. The average cost per unit of NOMS comprehension improvement was $1,152 per patient and NOMS verbal expression was $1,128 per patient.…”