抄録
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.
| 元の言語 | English |
|---|---|
| ページ（範囲） | 337-344 |
| ページ数 | 8 |
| ジャーナル | Topics in Stroke Rehabilitation |
| 巻 | 24 |
| 発行部数 | 5 |
| DOI | |
| 出版物ステータス | Published - 2017 |
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ASJC Scopus subject areas
- Medicine(all)
- Rehabilitation
- Community and Home Care
- Clinical Neurology
これを引用
Cost effectiveness of the occupation-based approach for subacute stroke patients : Result of a randomized controlled trial. / Nagayama, Hirofumi; Tomori, Kounosuke; Ohno, Kanta; Takahashi, Kayoko; Nagatani, Ryutaro; Izumi, Ryota; Moriwaki, Kensuke; Yamauchi, Keita.
：: Topics in Stroke Rehabilitation, 巻 24, 番号 5, 2017, p. 337-344.研究成果: Article
}
TY - JOUR
T1 - Cost effectiveness of the occupation-based approach for subacute stroke patients
T2 - Result of a randomized controlled trial
AU - Nagayama, Hirofumi
AU - Tomori, Kounosuke
AU - Ohno, Kanta
AU - Takahashi, Kayoko
AU - Nagatani, Ryutaro
AU - Izumi, Ryota
AU - Moriwaki, Kensuke
AU - Yamauchi, Keita
PY - 2017
Y1 - 2017
N2 - 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.
AB - 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.
KW - Cost effectiveness
KW - Occupational therapy
KW - Randomized controlled trial
KW - Stroke care
UR - http://www.scopus.com/inward/record.url?scp=85019922142&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85019922142&partnerID=8YFLogxK
U2 - 10.1080/10749357.2017.1289686
DO - 10.1080/10749357.2017.1289686
M3 - Article
C2 - 28198661
AN - SCOPUS:85019922142
VL - 24
SP - 337
EP - 344
JO - Topics in Stroke Rehabilitation
JF - Topics in Stroke Rehabilitation
SN - 1074-9357
IS - 5
ER -