Background
Stroke is a leading cause of death and a source of persistent disability around the world.[1] Annually, 6.7 million people die from stroke, representing 12 % of all global deaths.[2] As a disease of aging, the prevalence of stroke is expected to increase significantly around the world in the years ahead as the global population older than 65 years of age continues to increase by approximately nine million people per year.[3] Stroke survivors often encounter severe cognitive and emotional consequences.[4] Post-stroke depressive symptoms occur frequently in the chronic phase after stroke.[5–9] Recent data from the National Stroke Association (United Kingdom) show that approximately one-third of stroke survivors is affected by varying degrees of post-stroke depression amongst other symptoms.[10] In addition, these symptoms often coincide with increased feelings of anxiety.[11] Besides the major impact on health-related quality of life (HRQol),[12] post-stroke depressive symptoms are associated with increased hospitalization and therefore substantial healthcare costs.[13]
Stroke puts a high burden of disease on patients and their caregivers, as well as a considerable financial burden on society. Currently, approximately 3–4 % of total healthcare expenditures in Western countries are spent on stroke.[14] Even greater healthcare expenditures are likely in the near future, with expected increases in the elderly population and the availability of new and better treatments for stroke patients. As healthcare resources are limited and choices have to be made, interest in the economic aspect of stroke and cost-effective stroke-specific interventions has increased in the past few years.[15]
Previous research has been used to evaluate different interventions focusing on the treatment of post-stroke depressive symptoms, such as pharmacological interventions,[16,17] yet evidence for the effectiveness of stroke-specific psychological interventions is limited.[18] This is mainly related due to possible lack of efficacy of the interventions under investigation, but also caused by poor study design.[19] There are, however, indications that the use of cognitive behavioural therapy (CBT) might be both effective and cost-effective, based on the treatment of other chronic conditions.[20–25] Psychological interventions, such as CBT, seem promising in terms of effectiveness because they result in fewer side effects than medication and have a stronger effect on preventing relapse of symptoms than pharmacotherapy.[20,26–29] With respect to psychological interventions, fewer side effects and reduction in relapse are potentially strong indicators for cost-effectiveness. Furthermore, the characteristics of CBT seem to suggest it ought to be an especially good fit to meet the needs of people who suffer from post-stroke depression.[17] Depressed stroke survivors endorse significantly more negative conditions than non-depressed stroke survivors[30,31] In addition, there is good evidence that remaining active, expressing emotion and finding positive meaning ensures good psychological adjustment in other chronic illnesses.[32]
The current study describes the cost-effectiveness and cost-utility of a cognitive behavioural therapy augmented with occupational and movement therapy to support stroke patients with depressive symptoms in goal setting and goal attainment (augmented CBT) for stroke patients suffering from post-stroke depressive symptoms, in comparison with a computerized cognitive training program (CogniPlus) as a control intervention. Our aim was to determine the cost-effectiveness of both interventions from a societal perspective.
BMC Neurol. 2015;15(266) © 2015 BioMed Central, Ltd.
