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Assessment of computer-aided assistive technology: analysis of outcomes and costs |
Hass U, Andersson A, Brodin H, Persson J |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology Computer-Aided Assistive Technology (CAAT) for individuals with communication disabilities.
Type of intervention Treatment and rehabilitation.
Economic study type Cost-effectiveness analysis.
Study population Male and female individuals with communication disabilities who were referred to the regional CAAT centres.
Setting CAAT centres. The economic study was carried out in Uppsala, Sweden.
Dates to which data relate The main effectiveness data were taken from a single trial conducted between 1992 and 1994. Data were collected through questionnaires administered to the CAAT specialists and the clients. Resource and cost data were taken from 1992-94 sources. The price year was 1993.
Source of effectiveness data The estimates of goal fulfilment, health-related quality of life, and the Modified Rosser Disability and Distress Ratings (MRDDR) were derived from a single trial.
Link between effectiveness and cost data The costing was undertaken prospectively on the same patient sample as that used in the effectiveness study.
Study sample Overall, 87 individuals (49% female) were asked to participate in the study. The clients were classified based on their impairment (21 clients had one impairment) or combination of impairments (53 had a combination of impairments underlying the communication disability). Motor impairment in the upper extremities (34) and speech impairment (24) were most frequent. Twenty percent of the clients had a progressive disease that influenced their disability. The average age of the population was 24 years (range: 5 - 74 years). Most clients were between the ages of 5 and 20 years (64%). No difference in age distribution was found between male and female clients. Power calculations to determine the sample size were not undertaken.
Study design Before and after study. The duration of the follow-up was not stated. Seven of the eight CAAT centres participated. The loss to follow-up was 17%. The rate of returned questionnaires varied between 62% and 97%.
Analysis of effectiveness The analysis of effectiveness was based on treatment completers only. The primary health outcomes were goal fulfilment, health-related quality of life (HRQL), and the Modified Rosser Disability and Distress Ratings (MRDDR).
Effectiveness results The goal fulfilment score was, on average, 8.6 (of 10) for type H goals (handling), 7.9 for type F goals (function) and 7.4 for type A goals (activities). No significant changes over time in HRQL were found for the whole study population in the four dimensions (p values:0.6701, 0.0776, 0.6026 and 0.8939, respectively) from the Nottingham Health Profile (prior to and after implementation of CAAT):energy (21.5 and 17.5), social isolation (9.7 and 14.6), pain (11.5 and 9.5) and sleep (11.6 and 11.9). The MRDDR was likely to be most sensitive for changes in utility for persons with speech impairment (-0.56) versus other impairments (+0.47).
Clinical conclusions Usage of CAAT diminishes disability and increases skills in handling computers. However, the outcomes are not entirely positive regarding handicap, health-related quality of life and utility.
Measure of benefits used in the economic analysis No summary benefit measure was used in the analysis and as such the benefits are considered to be the same as the outcome measures.
Direct costs Costs for the selection process, including client assessment, tryouts, staff, usage training and selected equipment were included in the analysis. Information on prices was derived from the Assistive Technology Center in Ostergotland and AB Sjukvardhuvudmannens upphandlingsbolag. Resources were reported separately from the prices. A 5% discount rate was applied (3-year lifespan). The quantity/cost boundary adopted was the hospital. The price year was 1992.
Statistical analysis of costs Sensitivity analysis No sensitivity analysis was performed.
Estimated benefits used in the economic analysis The goal fulfilment score was, on average, 8.6 (of 10) for type H goals (handling), 7.9 for type F goals (function) and 7.4 for type A goals (activities). No significant changes over time in HRQL were found for the whole study population in the four dimensions (p values:.6701, .0776, .6026 and .8939, respectively) from the Nottingham Health Profile (prior to and after implementation of CAAT):energy (21.5 and 17.5), social isolation (9.7 and 14.6), pain (11.5 and 9.5) and sleep (11.6 and 11.9). The MRDDR was likely to be most sensitive for changes in utility for persons with speech impairment (-0.56) versus other impairments (+0.47).
Cost results The average total cost (for the first year) of the prescribed computer technologies was SEK 14,800. The selection process represented about 30% of the total first year costs. A 5% discount rate was applied. The price year was 1992.
Synthesis of costs and benefits Costs and benefits were not combined.
Authors' conclusions The study shows that the usage of CAAT involves reasonable marginal costs for the selection process and equipment. Usage of CAAT diminishes disability and increases skills in handling computers. However, the outcomes are not entirely positive regarding handicap, HRQL and utility. Those with speech impairment showed a lower goal fulfilment in activities/roles and had a more impaired utility rating after usage of CAAT compared with those with other impairments.
CRD COMMENTARY - Selection of comparators The reason for the choice of the comparator is clear. Individuals with a variety of impairments have been presumed to benefit from using a computer as a communication aid. You, as a user of this database, should consider whether these are widely used health technologies in your own setting. Validity of estimate of measure of benefit No ummary benefit measure was used in the analysis and as such the authors conducted a cost and outcomes analysis. The data do not appear to have been used selectively. Furthermore, the study included persons who had a progressive disease which influenced their ability to communicate, or young clients who developed communication ability spontaneously. As the authors pointed out, the homogeneity of the study population was low and the outcomes were presented as relative measures. As the population contained more persons with multiple impairments and fewer persons with profound visual impairment, the range of variety of clients, selected equipment and outcomes associated with implementation of CAAT was not shown. Validity of estimate of costs Resource quantities were reported separately from the prices. Adequate details of methods of quantity/cost estimation were given. As costs of training arranged by bodies other than the regional CAAT centres was not included in the analysis, the total cost of CAAT might have been underestimated. As no statistical analysis was conducted, the costs need to be treated with a degree of caution. Other issues The issue of generalisability to other settings or countries was not addressed. However, appropriate comparisons were made with other studies in terms of quantitative assessment of CAAT regarding both costs and outcomes. As the authors noted, the study has weaknesses concerning confounders. Changes in life influencing the ratings of HRQL and/or utility, such as provision of other assistive devices and health problems were not included in the analysis. Furthermore, as analysis of proxy measurements showed that the assistants sometimes had difficulty interpreting and adjusting the questions so that they were understandable to the client, the study might have some elements of bias. Implications of the study Further research is required within the context of a homogenous population. Furthermore, elements of bias due to the presence of confounders and proxy measurements need to be excluded from the analysis. Source of funding Financed by the Swedish Handicap Institute, the County Council of Ostergotland and the Swedish Council for Social Research (SFR 92-0201:1C).
Bibliographic details Hass U, Andersson A, Brodin H, Persson J. Assessment of computer-aided assistive technology: analysis of outcomes and costs. AAC: Augmentative and Alternative Communication 1997; 13(2): 125-135 Indexing Status Subject indexing assigned by CRD MeSH Adolescent; Adult; Aged; Child; Child, Preschool; Communication Aids for Disabled /economics; Computers /economics; Cost-Benefit Analysis; Costs and Cost Analysis; Female; Male; Middle Aged; Sweden AccessionNumber 21998007570 Date bibliographic record published 31/10/1999 Date abstract record published 31/10/1999 |
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