Cost-effectiveness of high-intensity training versus conventional therapy for individuals with subacute stroke

Abstract Objective This investigation estimated the incremental cost-effectiveness of HIT as compared to conventional physical therapy in individuals with subacute stroke, based on the additional personnel required to deliver the therapy. Design Secondary analysis from a pilot study and subsequent randomized controlled trial. Setting Outpatient laboratory setting. Participants Data were collected from individuals with locomotor impairments 1-6 months post-stroke participated in high-intensity training (HIT; n=27) or conventional physical therapy (n=17). Interventions Individuals performing HIT practiced walking tasks in variable contexts (stairs, overground, treadmill) while targeting up to 80% maximum heart rate reserve. Individuals performing conventional therapy practiced impairment-based and functional tasks at lower intensities ( Main outcome measures Costs were assessed based on personnel use with availability of similar equipment. Incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves were calculated for quality-adjusted life years (QALYs) derived from Medical Outcomes Short-Form 36 questionnaire and gains in self-selected gait speeds (SSS). Results Personnel costs were higher following HIT (mean [SD]; $1420 [234]) versus conventional therapy ($1111 [219]), although between-group differences in QALYs (0.05, 95% CI: 0.0-0.10) and SSS (0.20, 95% CI: 0.05-0.35) favored HIT. ICERs were $6180 (95% CI: -$96,364 to $123,211) per QALY and $155 (95% CI: 38 to 242) for a 0.1 m/s gain in SSS. Conclusions Additional personnel to support HIT are relatively inexpensive but can add substantial effectiveness to subacute rehabilitation. Future research should evaluate patient factors that increase the likelihood of improvement to maximize the cost-effectiveness of treatment post-stroke.