Cost-Effectiveness of Treating Upper Limb Spasticity Due to Stroke with Botulinum Toxin Type A: Results from the Botulinum Toxin for the Upper Limb after Stroke (BoTULS) Trial (original) (raw)
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Health technology assessment (Winchester, England), 2010
To compare the clinical effectiveness and cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A plus an upper limb therapy programme with the upper limb therapy programme alone. A multicentre open-label parallel-group randomised controlled trial and economic evaluation. Twelve stroke services in the north of England, UK. Three hundred and thirty-three adults with upper limb spasticity at the shoulder, elbow, wrist or hand and reduced upper limb function due to stroke more than 1 month previously. The intervention group received botulinum toxin type A injection(s) plus a 4-week programme of upper limb therapy. The control group received the upper limb therapy programme alone. Participants were clinically reassessed at 3, 6 and 9 months to determine the need for repeat botulinum toxin type A injection(s) and/or therapy. The primary outcome was upper limb function 1 month after study entry measured by the Action Research Arm Test (ARAT). A succe...
Cost-effectiveness of botulinum toxin type a in the treatment of post-stroke spasticity
Journal of Rehabilitation Medicine, 2005
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 The study compared three strategies for the treatment of post-stroke patients with flexed wrist or clenched fist spasticity. Strategy one was oral therapy alone with benzhexol, baclofen or tizanidine. Strategy two was injection with botulinum toxin Type A (BTX-A). Strategy three was oral therapy, followed by BTX-A as the second-line treatment option should oral therapy be unsuccessful. Patients were assumed to receive physiotherapy. Type of intervention Treatment. Economic study type Cost-effectiveness analysis. Study population As this was a modelling study, the target population comprised all patients in the UK population with wrist or clenched fist spasticity as a result of a stroke, and who were thus eligible for treatment. No further inclusion or exclusion criteria were reported. Setting As this was a modelling study, a setting was not explicitly stated at the outset. The economic study was carried out in the UK. Dates to which data relate Demographic data and data on the incidence rates of disease were derived from sources published between 1995 and 2001. Dates for the treatment effectiveness data and the resources used were not reported. The cost data were derived from sources published between 2002 and 2004. The price year was not explicitly reported. Source of effectiveness data The effectiveness data were based on expert opinion derived using a Delphi panel. Demographic and epidemiological data on the incidence of disease were derived from published sources.
Budget impact analysis of botulinum toxin A therapy for upper limb spasticity in the United Kingdom
ClinicoEconomics and Outcomes Research, 2015
Botulinum toxin A (BoNT-A) is an effective treatment for patients with upper limb spasticity (ULS), which is a debilitating feature of upper motor neuron lesions. BoNT-A preparations available in the UK are associated with different costs. Methods: We developed a budget impact model to assess the effect of changing market shares of different BoNT-A formulations-abobotulinumtoxinA, onabotulinumtoxinA, and incobotu-linumtoxinA-and best supportive care, from the UK payer perspective, over a 5-year time horizon. Epidemiological and resource use data were derived from published literature and clinical expert opinion. One-way sensitivity analyses were performed to determine parameters most influential on budget impact. Results: Base-case assumptions showed that an increased uptake of abobotulinumtoxinA resulted in a 5-year savings of £6,283,829. Treatment with BoNT-A costs less than best supportive care per patient per year, although treating a patient with onabotulinumtoxinA (£20,861) and incobotulinumtoxinA (£20,717) cost more per patient annually than with abo-botulinumtoxinA (£19,800). Sensitivity analyses showed that the most influential parameters on budget were percentage of cerebral palsy and stroke patients developing ULS, and the prevalence of stroke. Conclusion: Study findings suggest that increased use of abobotulinumtoxinA for ULS in the UK could potentially reduce total ULS cost for the health system and society.
Budget impact of botulinum toxin treatment for spasticity after stroke — a German perspective
Journal of Public Health, 2019
Aim Botulinum toxin agents can improve the quality of life of patients with post-stroke upper limb spasticity (ULS) and are recommended by international and German guidelines. However, health-services research indicates an underuse of botulinum toxin agents in this patient group. The study aims to clarify the budget impact of treatment with botulinum toxin agents according to the guidelines for all eligible patients with ULS in Germany compared to usual care. Methods The budgetary impact for the statutory health insurance system was estimated by calculating a Markov cohort model with a timeframe of 5 years comparing three treatment options. Four health states were included. The base-case analysis compares standard doses of two botulinum toxin agents to usual care. The model accounts for direct medical costs. Sensitivity analyses vary doses of botulinum toxin agents and prevalence of spasticity after stroke. Results In the base case, both botulinum toxin agents lead to increased costs compared to usual care. Treatment with Dysport ® (cumulative costs for the 5-year period: €280,321,317) is less expensive than the treatment with Xeomin ® (€377,511,529). Cumulative costs over 5 years in usual care are €61,306,062. Conclusion The botulinum toxin therapy is associated with additional costs, but an increased use of botulinum toxin would be consistent with guideline-based therapy. In particular, it has to be considered that spasticity as a chronic condition is accompanied by a relevant loss of quality of life. Thus, considering only the therapy costs may not be sufficient for making final therapeutic decisions.
Toxins
Service model changes at the North Staffordshire Rehabilitation Centre (UK) included switching spasticity treatment from onabotulinumtoxinA (onaBoNT-A) to abobotulinumtoxinA (aboBoNT-A). This noninterventional, retrospective, longitudinal study (NCT04396704) describes the clinical and economic outcomes in toxin-naive adults with spasticity who received onaBoNT-A (Cohort 1; 2015–2017) or aboBoNT-A (Cohort 2; 2017–2019). Outcomes included Goal Attainment Scale T (GAS-T) score, treatment satisfaction, quality of life (QoL; EQ-5D visual analog scale [VAS] score), and treatment costs. Adverse events were recorded for Cohort 2. Cohort 1 included 60 patients (mean [standard deviation] dose, 206.0 [98.8] U); Cohort 2 included 54 patients (753.7 [457.3] U). Mean (95% confidence interval) GAS-T scores for Cohorts 1 and 2 were 43.1 (39.3–46.9) and 47.8 (43.7–51.9) at Week 6, and 43.2 and 44.3 at Week 12, respectively. In both cohorts most patients were satisfied with treatment. At Week 12, QoL...
Exploration of Neuroprotective Therapy
Stroke is one of the most common causes of disability and exerts a high burden of direct and indirect costs. Stroke may cause spasticity, which limits patients’ abilities and affects their activities of daily living, decreasing their quality of life. Conventional treatments are based on physical therapy, anti-spasticity medication, and botulinum toxin type A (BTX-A). However, recently, non-pharmacological approaches have been used, such as dry needling (DN) of myofascial trigger points. BTX-A and DN are two treatments that aim to decrease spasticity in patients with stroke, but their mode of action, application, and costs differ. Thus, there is a need to determine the comparative economics of post-stroke spasticity treatments. For this purpose, a search for all types of cost-effectiveness studies (randomized controlled trials, matched controls, and cohorts) and models of epidemiological data was performed. Studies were selected if they included economic outcomes in stroke patients t...
Journal of Neurology, 2011
Botulinum toxin (BTA) is a safe and effective therapeutic tool for many neurological conditions but few studies have investigated its real cost in neurological practice. We evaluated the daily cost of botulinum toxin type A (BTA) treatment through a cost effectiveness analysis alongside a prospective study of BTA injections at a French University Hospital over a 2-year follow-up period. The data of 3,108 BTA injections performed in 870 adult patients presenting with dystonia, facial hemispasm, or spasticity were entered in the database. Patients were questioned at each visit about the subjective effectiveness of the previous injection. The daily cost of BTA treatment was calculated as the ratio of each session's cost (including all additional costs) to the duration of subjective efficacy. The subjective rating of efficacy duration was 17.3 ± 7.7 weeks for facial hemispasm, 15.4 ± 7.7 for blepharospasm, 14.3 ± 6.7 for cervical dystonia, 14.5 ± 7.8 and 14.1 ± 7.4 weeks for upper and lower limb spasticity, respectively. The daily cost of BTA injections was 0.57 ± 0.20 € for facial hemispasm, 0.95 ± 0.30 € for blepharospasm, 2.85 ± 0.86 € for cervical dystonia, 3.38 ± 1.49 € and 3.62 ± 1.81 € for upper and lower limb spasticity, respectively. When associated costs were considered, the daily cost of BTA injections was clearly increased (45-93%) in limb spasticity or rigidity but remained only modestly increased (15-37%) in other indications. These results obtained in a large cohort of patients show that BTA treatment has a low daily cost for a long-lasting effect, with a daily cost/benefit ratio that greatly depends on the indications.
Journal of Rehabilitation Medicine, 2009
Objective: Botulinum toxin is known to relieve upper limb spasticity, which is a disabling complication of stroke. We examined its effect on quality of life and other person-centred perspectives. Design: A multi-centre, randomized, double-blind, placebocontrolled study. Patients: Ninety-six patients were randomized (mean age 59.5 years) at least 6 months post-stroke. Mean time since stroke was 5.9 years. Methods: Patients received either botulinum toxin type A or placebo into the affected distal upper limb muscles on 2 occasions, 12 weeks apart. Assessment was undertaken at baseline, 8, 12, 20 and 24 weeks. The primary outcome measure was the Assessment of Quality of Life scale (AQoL). Secondary outcome assessments included Goal Attainment Scaling (GAS), pain, mood, global benefit, Modified Ashworth Scale (MAS), disability and carer burden. Results: The groups did not differ significantly with respect to quality of life, pain, mood, disability or carer burden. However, patients treated with botulinum toxin type A had significantly greater reduction in spasticity (MAS) (p < 0.001), which translated into higher GAS scores (p < 0.01) and greater global benefit (p < 0.01). Conclusion: Although no change in quality of life was demonstrated using the AQoL, botulinum toxin type A was found to be safe and efficacious in reducing upper limb spasticity and improving the ability to achieve personal goals.