Thesis Defence: Applied Health Economics: Economic Evaluation of Lifestyle Interventions to Promote Cognition in Older Adults with Chronic Stroke

Cassandra Adjetey, supervised by Dr. Jennifer Davis, will defend their thesis titled “Applied Health Economics: Economic Evaluation of Lifestyle Interventions to Promote Cognition in Older Adults with Chronic Stroke” in partial fulfillment of the requirements for the degree of Master of Arts in Interdisciplinary Studies.

An abstract for Cassandra Adjetey’s thesis is included below.

Examinations are open to all members of the campus community as well as the general public. Registration is not required for in person defences.

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ABSTRACT

Background: Cognitive impairment is a common and costly consequence of a stroke, occurring in about 30% of stroke survivors. Evidence suggests exercise and cognitive training can improve cognitive function among individuals with chronic stroke. What remains unknown, is whether exercise and/or cognitive training are cost-effective compared with usual care.
Purpose: This study aims to examine the cost-effectiveness of exercise and cognitive training compared with a stretching and tone program from a healthcare system perspective of a 6-month intervention with a six-month follow-up.

Method: An economic evaluation alongside a 6-month randomized controlled trial involving 120 community-dwelling adults with chronic stroke (i.e., at least 12 months post-stroke) in Metro Vancouver, Canada. Participants were aged 55 years and older who did not have dementia and were able to walk six meters. Participants were randomly assigned to i) EX, a multi-component exercise of strength, aerobic, and balance training (n=34), ii) ENRICH, cognitive and social enrichment activities (n=34), or iii) BAT, a stretching and toning program (control) (n=52). The economic evaluation assessed cost-effectiveness and cost-utility as the incremental cost per change in the Alzheimer’s Disease Assessment Scale – Cognitive-Plus (ADAS-Cog-Plus) and incremental cost per Quality Adjusted life year (QALY) using the Euro-Qol 5D three-level of the interventions respectively. Costs are reported in 2022 Canadian Dollars.

Results: The mean age for all participants was 71 years (SD= 9) with about 46% female participants. At the end of the 6-month intervention, the incremental cost per change in ADAS-Cog-Plus showed that both EX and ENRICH were more effective and more costly compared with the BAT control group. The incremental benefits in ADAS-Cog were not sustained at 12 months. The incremental cost per change in QALY at 6 and 12 months showed that while EX was less costly and ENRICH more costly compared to the BAT group, the incremental QALYs gained for both interventions were negligible and not clinically significant.

Conclusion: Compared to stretching and toning, exercise training to improve post-stroke cognitive impairment was cost-effective. The cost-effectiveness of cognitive training activities depends on the decision-maker’s willingness to pay. This highlights the importance of exercise in stroke rehabilitation.