Background and purpose:
The cost effectiveness of occupational therapy for subacute stroke
patients is unclear in the extant literature. Consequently, this study
determined the cost effectiveness of the occupation-based approach using
Aid for Decision-Making in Occupation Choice (ADOC) for subacute stroke
patients compared with an impairment-based approach.
Methods:
We conducted an economic evaluation from a societal perspective
alongside a pilot randomized controlled trial, with a single blind
assessor for participants in 10 subacute rehabilitation units in Japan.
The intervention group received occupation-based goal setting using
ADOC, with interventions focused on meaningful occupations. The control
group received an impairment-based approach focused on restoring
capacities. For both groups, occupational-therapy intervention was
administered more than five times per week, for over 40 min each time,
and they received physical and speech therapy prior to discharge. The
main outcomes were quality-adjusted life years (QALYs) and total costs.
Further, sensitivity analyses were performed to examine the influence of
parameter uncertainty on the base case results.
Results:
The final number of participants was 24 in each of the two groups. In
terms of QALYs, the intervention group is significantly higher than the
control group (p = 0.001, difference 95% CI: 0.002–0.008) and
total costs are not statistically significant. Applying a
willingness-to-pay threshold of JPY 5 million/QALY, the probability of
the occupation-based approach using ADOC being cost effective was
estimated to be 65.3%.
Conclusions:
The results show that the occupation-based approach is associated with
significantly improved QALYs and has potential cost effectiveness,
compared with the impairment-based approach.
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