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

Humphreys, Ioan; Thomas, Shirley A.; Phillips, Ceri; Lincoln, Nadina

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.

Citation

Humphreys, I., Thomas, S. A., Phillips, C., & Lincoln, N. (2015). Cost analysis of the Communication and Low Mood (CALM) randomised trial of behavioural therapy for stroke patients with aphasia. Clinical Rehabilitation, 29(1), https://doi.org/10.1177/0269215514537656

• Journal Article Type: Article
• Acceptance Date: May 6, 2014
• Publication Date: Jan 1, 2015
• Deposit Date: Apr 5, 2018
• Publicly Available Date: Apr 5, 2018
• Journal: Clinical Rehabilitation
• Print ISSN: 0269-2155
• Electronic ISSN: 1477-0873
• Publisher: SAGE Publications
• Peer Reviewed: Not Peer Reviewed
• Volume: 29
• Issue: 1
• DOI: https://doi.org/10.1177/0269215514537656
• Keywords: Aphasia, clinical evaluation, cognitive impairment, economic evaluation, health status
• Public URL: https://nottingham-repository.worktribe.com/output/740200
• Publisher URL: http://journals.sagepub.com/doi/10.1177/0269215514537656