Economic Evaluation of Clinical, Nutritional and Rehabilitation Interventions on Oropharyngeal Dysphagia after Stroke: A Systematic Review

被引:7
|
作者
Marin, Sergio [1 ,2 ,3 ]
Ortega, Omar [1 ,3 ,4 ]
Serra-Prat, Mateu [4 ,5 ]
Valls, Ester [2 ]
Perez-Cordon, Laia [6 ]
Clave, Pere [1 ,3 ,4 ]
机构
[1] Univ Autonoma Barcelona, Hosp Mataro, Gastrointestinal Physiol Lab, Barcelona 08304, Spain
[2] Hosp Badalona Germans Trias & Pujol, Pharm Dept, Badalona 08916, Spain
[3] Inst Recerca Germans Trias & Pujol, Neurogastroenterol & Motil Res Grp, Badalona 08916, Spain
[4] Ctr Invest Biomed Red Enfermedades Hepat & Digest, Mataro 08340, Spain
[5] Hosp Mataro, Res Unit, Consorci Sanit Maresme, Mataro 08304, Spain
[6] Hosp Mataro, Pharm Dept, Consorci Sanit Maresme, Mataro 08304, Spain
关键词
deglutition disorders; nutrition therapy; stroke; brain ischemia/complications; cerebral haemorrhage; economics; health resources; systematic review; COST; CARE; MANAGEMENT; KINEMATICS; DISORDERS; DIAGNOSIS; RECOVERY;
D O I
10.3390/nu15071714
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
Background: Post-stroke oropharyngeal dysphagia (PS-OD) and its complications increase healthcare costs, suggesting that its appropriate management is cost-effective. We aimed to assess the efficiency of healthcare interventions in PS-OD management. Methods: A systematic review was conducted following PRISMA recommendations. Four databases were searched from inception through 30 June 2021. Outcome measures were cost-effectiveness and cost-savings of healthcare interventions. English and Spanish literature were included. Narrative and tables were used to present and synthesise evidence. Quality was evaluated using the CHEERS Statement. Results: A total of 244 studies were identified, and 10 were included. Screening and diagnosis of PS-OD studies found: (1) adjusted reduction in hospitalisation costs when assessed during the first admission day; (2) non-significant reduction in hospitalisation costs with OD management after thrombolysis; and (3) videofluoroscopy as the most cost-effective screening method (compared to bedside evaluation and a combination of both). Two studies showed cost-effective rehabilitation programmes, including OD management. Pelczarska et al. showed an incremental cost-utility ratio of texture-modified diets using a gum-based thickener of 20,977 PLN (4660(sic)) following a dynamic model, and Kotecki et al. commercially prepared thickened fluids that were 44% to 59% less expensive than in situ prepared fluids. Elia et al. showed home enteral nutrition was cost-effective (12,817 pound/QALY), and Beavan et al. showed higher nutrient intake and low increase in hospitalisation costs using looped-nasogastric tubes (5.20 pound for every 1% increase). Heterogeneity between studies precluded a quantitative synthesis. Conclusions: Included studies suggest that healthcare interventions aiming to prevent OD complications are cost-effective. However, studies assessing novel strategies are needed.
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页数:22
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