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4CPS-116 The efficiency and cost-effectiveness of healthcare and nutritional interventions in the management of post-stroke oropharyngeal dysphagia, results of a systematic review
  1. S Marin1,
  2. O Ortega2,
  3. M Serra-Prat3,
  4. E Valls1,
  5. L Pérez-Cordón4,
  6. C Codina-Jiménez1,
  7. P Clavé2
  1. 1Hospital Universitari Germans Trias I Pujol, Pharmacy Department, Badalona, Spain
  2. 2Hospital de Mataró, Gastrointestinal Physiology Laboratory, Mataró, Spain
  3. 3Hospital de Mataró, Research Unit, Mataró, Spain
  4. 4Hospital de Mataró, Pharmacy Department, Mataró, Spain


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


  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

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