ClinicoEconomics and Outcomes Research (Dec 2023)
The Cost-Effectiveness of Chin Tuck Against Resistance Compared to Usual Care in Citizens with Oropharyngeal Dysphagia – An Economic Evaluation
Abstract
Line Dyreborg,1,2 Sabine Michelsen Raunbak,2 Sabrina Storgaard Sørensen,2 Dorte Melgaard,3– 5 Signe Westmark1 1Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark; 2Danish Center for Health Services Research, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; 3North Denmark Regional Hospital, Hjørring, Denmark; 4Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; 5Mech-sense, Aalborg University Hospital, Aalborg, DenmarkCorrespondence: Signe Westmark, North Denmark Regional Hospital, Bispensgade 37, Hjørring, DK-9800, Denmark, Tel +45 2041 6541, Email [email protected]: This study aims to evaluate the cost-effectiveness of chin tuck against resistance (CTAR) for citizens suffering from dysphagia compared to the standard municipal treatment in Denmark.Patients and Methods: A cost-utility analysis, employing a municipal perspective, was conducted using cost data collected alongside clinical data of a randomized controlled trial evaluating the effect of CTAR training for citizens with dysphagia. The composition of the clinical randomized controlled trial, which included citizens with different diagnoses, means that participants had different disease courses. Ninety-two citizens from seven different Danish municipalities were enrolled, of whom 43 received standard care, and 49 received CTAR in addition to standard care. The effect outcome of the economic evaluation was quality-adjusted life years (QALY), estimated using the EQ-5D-5L questionnaire. Individual resource consumption of each citizen was determined based on the use of home care, home nursing care, physio- and occupational therapy, dietitian guidance, and hospital admissions. The incremental costs and QALYs between the intervention group (CTAR in addition to standard care) and standard care group were estimated using regression analysis, and sensitivity analyses were performed to investigate the robustness of the results.Results: The base case analysis showed that the intervention group was dominant compared to the standard care group, with a decrease in incremental costs of £ 542.38 and an increase in incremental QALYs of 0.0118. All sensitivity analyses demonstrated similar findings as the base case analysis, supporting the robustness of the results.Conclusion: This study found that the intervention group was the dominant alternative, hence being more effective and cost-saving, compared to the standard care group in a Danish municipality perspective with a three-month time horizon. This study adds to the scarce evidence on the cost-effectiveness of CTAR in a Danish clinical setting, but further studies should focus on estimating long-term cost-effectiveness.Keywords: cost-utility analysis, exercise, swallowing disorders, municipality, quality of life
