title: Cost-effectiveness of Intrathecal Baclofen Therapy in severe refractory non-focal disabling spasticity: a Spanish hospital perspective.
abstract: BACKGROUND
  Current knowledge about long-term economic consequences of Intrathecal Baclofen Therapy (ITB Therapy®) is incomplete.
  
  
  METHODS
  A markov model was developed to estimate long-term clinical and economic outcomes with ITB Therapy® and conventional medical management of severe refractory non-focal disabling spasticity. Clinical and cost inputs were obtained through a non-interventional, prospective, observational study in a Spanish neurorehabilitation hospital.
  
  
  RESULTS
  ITB Therapy® increased remaining lifetime costs by €35,605 and resulted in a gain of 1.06 quality-adjusted life-years (QALYs), thus showing an incremental cost-effectiveness ratio (ICER) of €33,619/QALY gained. In alternative scenarios, reflecting other clinical settings and management options, considerably lower ICER values were obtained. In particular, opportunities were identified to improve efficiency by setting clinically and economically sound targets for post-operation length of stay.
  
  
  CONCLUSIONS
  In the Spanish setting, ITB Therapy® resulted in an ICER close to €30,000/QALY gained; potential ways to reduce costs and further enhance efficiency can be identified.
authors.affiliation: a Fundació Institut Guttmann , Institut Universitari de Neurorehabilitació adscrit a la UAB , Badalona , Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Vidal
authors.affiliation: b Universitat Autònoma de Barcelona , Bellaterra , Spain.
authors.forename: John
authors.initials: J
authors.lastname: Slof
authors.affiliation: c Autonomous Consultant , Barberá del Vallés , Spain.
authors.forename: David
authors.initials: D
authors.lastname: Serrano
authors.affiliation: a Fundació Institut Guttmann , Institut Universitari de Neurorehabilitació adscrit a la UAB , Badalona , Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Marqués
authors.affiliation: a Fundació Institut Guttmann , Institut Universitari de Neurorehabilitació adscrit a la UAB , Badalona , Spain.
authors.forename: Hatice
authors.initials: H
authors.lastname: Kumru
authors.affiliation: a Fundació Institut Guttmann , Institut Universitari de Neurorehabilitació adscrit a la UAB , Badalona , Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Benito-Penalva
mesh_terms: D000328:Adult; D001418:Baclofen / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007902:Length of Stay; D008297:Male; D008390:Markov Chains; D009125:Muscle Relaxants, Central / Q000191:economics / Q000627:therapeutic use*; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000191:economics; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012047:Rehabilitation Centers / Q000191:economics; D012720:Severity of Illness Index; D013030:Spain
chemical_list: D009125:Muscle Relaxants, Central; D001418:Baclofen
keywords: ITB; Spain; Spasticity; cost-effectiveness; intrathecal baclofen therapy; neurorehabilitation