Cost-effectiveness of botulinum toxin type a in the treatment of post-stroke spasticity.
OBJECTIVE
Treatment strategies for post-stroke spasticity include oral anti-spastic drugs, surgery, physiotherapy and botulinum toxin type A injection. The objective of this study was to compare the cost-effectiveness and outcomes of oral therapy vs. botulinum toxin type A treatment strategies in patients with flexed wrist/clenched fist spasticity.


METHODS
Treatment outcome and resource use data were collected from an expert panel experienced in the treatment of post-stroke spasticity. A decision tree model was developed to analyse the data.


RESULTS
Thirty-five percent of patients receiving oral therapy showed an improvement in pre-treatment functional targets which would warrant continuation of therapy, compared with 73% and 68% of patients treated with botulinum toxin type A first- and second-line therapy, respectively. Botulinum toxin type A treatment was also more cost-effective than oral therapy with the "cost-per-successfully-treated month" being 942 pounds, 1387 pounds and 1697 pounds for botulinum toxin type A first-line, botulinum toxin type A second-line and oral therapy, respectively.


CONCLUSIONS
In conclusion, botulinum toxin type A is a cost-effective treatment for post-stroke spasticity.
Ward
Anthony
A
North Staffordshire Rehabilitation Unit, The Hayward, Stoke-on-Trent, Staffordshire, UK.
Roberts
Graeme
G
Warner
Juliet
J
Gillard
Samantha
S
D000284:Administration, Oral; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D007273:Injections, Intramuscular; D018803:Models, Economic; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000191:economics; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000191:economics / Q000209:etiology / Q000534:rehabilitation; D009465:Neuromuscular Agents / Q000008:administration & dosage* / Q000191:economics; D020521:Stroke / Q000150:complications* / Q000191:economics / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D009125:Muscle Relaxants, Central; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A