Cost-effectiveness modeling of intrathecal baclofen therapy versus other interventions for disabling spasticity.
OBJECTIVE
To assess by simulation the cost-effectiveness of intrathecal baclofen (ITB) therapy compared with conventional medical treatments for patients with disabling spasticity and functional dependence caused by any neurological disease.


METHODS
Two models were created to simulate therapeutic strategies for managing severe spasticity, one with and one without the use of ITB, to assess various treatment sequences over 2 years based on current medical practices in France. Successful treatment at each evaluation was defined as a combination of: (1) the increased patient and caregiver satisfaction as assessed by goal attainment scaling (GAS), and (2) a decrease of at least 1 point on the Ashworth score. Probabilistic sensitivity analyses were performed using 5000 Monte-Carlo simulations taking into account specific distribution curves for direct costs and effectiveness parameters in each treatment option.


RESULTS
The model simulations suggest that including ITB as a first option strategy in the management of function of severely impaired patients with disabling spasticity results in a higher success rate (78.7% vs 59.3%; P < .001). In addition, the ITB therapy model revealed a lower cost (pound 59,391 vs pound 88,272; P < .001) and an overall more favorable cost-effectiveness ratio (pound 75,204/success vs pound 148,822/success; P < .001), compared with conventional medical management without ITB.


CONCLUSIONS
Within the assumptions of our modeling, ITB therapy evaluated by a combination of treatment success criteria at 6-month intervals over a 2-year period may be a cost-effective strategy compared to conventional medical management alone.
Bensmail
D
D
Department of Physical Medicine and Rehabilitation, Groupe Hospitalier R. Poincaré-Hôpital Maritime de Berck, AP-HP, Versailles-Saint Quentin University, Garches, France.
Ward
A B
AB
Wissel
J
J
Motta
F
F
Saltuari
Leopold
L
Lissens
J
J
Cros
S
S
Beresniak
A
A
D001418:Baclofen / Q000008:administration & dosage / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000150:complications; D003131:Combined Modality Therapy / Q000191:economics* / Q000379:methods; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007278:Injections, Spinal; D018803:Models, Economic; D009103:Multiple Sclerosis / Q000150:complications; D009125:Muscle Relaxants, Central / Q000008:administration & dosage / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D009493:Neurosurgery / Q000191:economics; D026741:Physical Therapy Modalities / Q000191:economics; D011788:Quality of Life / Q000523:psychology; D020127:Recovery of Function; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications; D016896:Treatment Outcome
D009125:Muscle Relaxants, Central; D001418:Baclofen