Economic analysis of the ‘Take Charge’ intervention for people following stroke: Results from a randomised trial

• Published in: Clinical rehabilitation Vol. 36; no. 2; pp. 240 - 250
• Main Authors: Te Ao, Braden, Harwood, Matire, Fu, Vivian, Weatherall, Mark, McPherson, Kathryn, Taylor, William J, McRae, Anna, Thomson, Tom, Gommans, John, Green, Geoff, Ranta, Annemarei, Hanger, Carl, Riley, Judith, McNaughton, Harry
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-02-2022; Sage Publications Ltd
• Subjects: Adult; Cost analysis; Cost-Benefit Analysis; Dosage; Economic analysis; Health care expenditures; Humans; Intervention; Quality adjusted life years; Quality of Life; Rehabilitation; Sensitivity analysis; Stroke; Surveys and Questionnaires; Willingness to pay; cost-utility analysis; Stroke rehabilitation; cost-effective; self-management
• ISSN: 0269-2155; 1477-0873
• DOI: 10.1177/02692155211040727

Objective:
To undertake an economic analysis of the Take Charge intervention as part of the Taking Charge after Stroke (TaCAS) study.
Design:
An open, parallel-group, randomised trial comparing active and control interventions with blinded outcome assessment
Setting:
Community.
Participants:
Adults (n = 400) discharged to community, non-institutional living following acute stroke.
Interventions:
The Take Charge intervention, a strengths based, self-directed rehabilitation intervention, in two doses (one or two sessions), and a control intervention (no Take Charge sessions).
Measures:
The cost per quality-adjusted life year (QALY) saved for the period between randomisation (always post hospital discharge) and 12 months following acute stroke. QALYs were calculated from the EuroQol-5D-5L. Costs of stroke-related and non-health care were obtained by questionnaire, hospital records and the New Zealand Ministry of Health.
Results:
One-year post hospital discharge cost of care was mean (95% CI) $US4706 (3758–6014) for the Take Charge intervention group and $6118 (4350–8005) for control, mean (95% CI) difference $ −1412 (−3553 to +729). Health utility scores were mean (95% CI) 0.75 (0.73–0.77) for Take Charge and 0.71 (0.67–0.75) for control, mean (95% CI) difference 0.04 (0.0–0.08). Cost per QALY gained for the Take Charge intervention was $US −35,296 (=£ −25,524, € −30,019). Sensitivity analyses confirm Take Charge is cost-effective, even at a very low willingness-to-pay threshold. With a threshold of $US5000 per QALY, the probability that Take Charge is cost-effective is 99%.
Conclusion:
Take Charge is cost-effective and probably cost saving.