title: Cost effectiveness of the occupation-based approach for subacute stroke patients: result of a randomized controlled trial.
abstract: 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.
  
  
  
  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.
  
  
  
  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%.
  
  
  
  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.
authors.affiliation: a Department of Occupational Therapy , Kanagawa University of Human Services , Yokosuka , Japan.|g Graduate School of Health Management , Keio University , Fujisawa , Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Nagayama
authors.affiliation: b Unit of Rehabilitation Sciences , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.
authors.forename: Kounosuke
authors.initials: K
authors.lastname: Tomori
authors.affiliation: c IMS Itabashi Rehabilitation Hospital , Itabashi , Japan.
authors.forename: Kanta
authors.initials: K
authors.lastname: Ohno
authors.affiliation: d Department of Occupational Therapy, School of Allied Health Sciences , Kitasato University , Sagamihara , Japan.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: a Department of Occupational Therapy , Kanagawa University of Human Services , Yokosuka , Japan.
authors.forename: Ryutaro
authors.initials: R
authors.lastname: Nagatani
authors.affiliation: e Department of Occupational Therapy , Seirei Christopher University , Hamamatsu , Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Izumi
authors.affiliation: f Department of Medical Statistics , Kobe Pharmaceutical University , Kobe , Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Moriwaki
authors.affiliation: g Graduate School of Health Management , Keio University , Fujisawa , Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Yamauchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000191:economics / Q000379:methods*; D017063:Outcome Assessment, Health Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D016037:Single-Blind Method; D020521:Stroke / Q000191:economics / Q000628:therapy*; D000071939:Stroke Rehabilitation / Q000191:economics / Q000379:methods*
keywords: Cost effectiveness; occupational therapy; randomized controlled trial; stroke care