Discussion
chronic stroke, cognitive and social enrichment, cognitive improvements
This economic evaluation using data from the Vitality study found that at the end of the 6-month intervention, the exercise program was more effective in improving cognitive function among older adults with chronic stroke at additional cost compared with the control balance and tone program. As demonstrated by the primary RCT, exercise led to significant cognitive improvements, surpassing the MCID of 3 points on the 13-item ADAS-Cog.The cost-utility analysis demonstrated that neither exercise nor cognitive and social enrichment activities led to changes in health-related quality of life at the end of the intervention and follow-up. This study was powered to detect changes in cognitive function rather than quality of life; therefore, it lacked statistical power to detect differences in quality of life. Additionally, the limited responsiveness of the EQ-5D-3L might not capture condition-specific changes in quality of life.The social and cognitive enrichment intervention had higher delivery costs, and participants use more health care resources. Exercise, despite being more costly to deliver than the balance and tone program, led to the lowest health care resource utilization. Participants in the exercise group had lower health care costs for practitioner visits and laboratory tests. We posit that this may be attributed to exercise leading to improvement in cardiovascular fitness and overall health, resulting in reduced visits to practitioners.The exploratory subgroup analyses revealed that exercise was cost-saving for participants aged 80 years and older. This finding aligns with previous research that has demonstrated cost savings associated with exercise as a fall prevention strategy in older adults.This study provides novel health economic data on the effectiveness of exercise for improving cognitive function in older adults with chronic stroke. Furthermore, since this was a trial-based economic evaluation, the study benefits from the design of the clinical trial, such as randomization and blinding, ensuring comparable data collection among intervention and control groups.