Background and Importance Post-stroke oropharyngeal dysphagia (PS-OD) causes significant high costs during hospitalisation that increase with the development of malnutrition and respiratory infections at long-term. This data suggests that the appropriate management of PS-OD including the use of early detection programmes, texture-modified diets, commercially thickened fluids, domiciliary enteral nutrition, and rehabilitation programmes including restorative treatments could lead to cost-effective reduction of clinical complications.¹

Aim and Objectives To assess literature on the efficiency and cost-effectiveness of available healthcare interventions on the management of PS-OD.

Material and Methods Systematic review following PRISMA recommendations. MEDLINE, Embase, NHS-EED and CEA-Registry were searched up to 30 June 2021 to include studies on PS-OD. Outcomes of interest were the efficiency and the cost-effectiveness of healthcare interventions on the management of PS-OD. Economic evaluation studies were included. Oesophageal dysphagia and non-stroke studies were excluded.

Results 235 studies were identified and 10 included. Svendsen-et-al found lower hospitalisation costs (HC) (USD12,556 CI95% 9,751-15,361) when PS-OD was assessed during the first 24 hours after admission. Liu-et-al did not find differences in HC when PS-OD was assessed with the water swallowing vs volume-viscosity swallowing test if the water test failed. Schwartz-et-al found a non-significant reduction on HC (Australian dollars18,053 vs 16,548, p=0.722) using a protocol to manage OD after thrombolysis. Wilson et-al showed video fluoroscopy as the most cost-effective screening method compared to bedside evaluation and a combination of both. Khiaocharoen et-al and Suksathien et-al showed cost-effective rehabilitation programmes that included OD management. Pelczarska et-al showed that the use of texture-modified diets using a gum-based thickener (Nutilis Clear®) was cost-effective (PLN21,387-20,977 per QALY), and Kotecki et-al that commercially thickened fluids use was more efficient than in situ preparation. Elia et-al showed domiciliary enteral nutrition cost-effective (£12,817 per QALY) and Beavan-et-al showed higher nutrient intake and low HC increase using looped-nasogastric tube (5,20 sterling for every 1% increase).

Conclusion and Relevance Healthcare interventions to manage PS-OD with a positive clinical effect tend to be cost-effective. Future studies assessing the cost-effectiveness of applying compensatory and/or restorative strategies among with reporting cost-savings by appropriate PS-OD early evaluation and management are ne

References

1. Marin S, et al. Economic evaluations of health care interventions in oropharyngeal dysphagia after stroke: protocol for a systematic review. Syst Rev. 2022;11(1): 92.

Conflict of Interest No conflict of interest