Jacobs Molly, Briley Patrick M, Wright Heather Harris, Ellis Charles
Department of Health Services and Information Management. East Carolina University, USA.
Communication Equity and Outcomes Laboratory, East Carolina University, USA.
J Telemed Telecare. 2023 May;29(4):271-281. doi: 10.1177/1357633X20982773. Epub 2021 Jan 20.
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.
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.
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.
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.
很少有研究报告与传统面对面失语症治疗的成本效益相关的信息。失语症治疗远程实践方法的出现和需求，使得迫切需要了解这种方法的成本和成本效益。
18名失语症中风幸存者完成了基于社区的失语症远程康复治疗，采用通过Webex视频会议程序提供的语言导向治疗（LOT）。治疗的边际效益计算为治疗前后西方失语症成套测验修订版（WAB-R）分数的变化，治疗的边际成本计算为WAB-R失语商（AQ）变化与每次治疗平均成本之间的关系。在控制人口统计学变量的情况下，贝叶斯估计评估了WAB-R变化的主要影响因素，并按失语症类型评估了治疗的成本效益。
18名参与者中有13名在接受远程康复治疗后WAB-R AQ有显著改善。与命名性失语（参考组）相比，传导性失语患者的改善水平相对相似，而布罗卡失语患者的改善较小。完全性失语患者的改善最大。根据失语症类型/严重程度，改善者每提高1分的成本在89美元至864美元之间（平均=200美元）。
严重失语症患者可能从治疗中获得最高的单位成本收益。改善幅度和单位改善成本均受失语症类型、严重程度和种族的影响。通过治疗各种严重程度的不同类型失语症，可将失语症治疗成本的规模经济降至最低。
