title: Regional disparities in botulinum toxin A (BoNT-A) therapy for spasticity in Sweden: budgetary consequences of closing the estimated treatment gap.
abstract: OBJECTIVE
  As no national treatment guidelines for spasticity have been issued in Sweden, different regional treatment practices may potentially occur. This study examines botulinum toxin A (BoNT-A) treatment for spasticity on a regional level in Sweden and presents budgetary consequences of closing the estimated treatment gap.
  
  
  METHODS
  Prevalence of spasticity in Sweden was estimated from published data. Regional sales data for BoNT-A were acquired from IMS Health. A set proportion of hospital BoNT-A use was assumed to represent treatment of spasticity. Total intervention cost of BoNT-A treatment was gathered from healthcare regional tariffs, while costs associated with spasticity were derived from publications on multiple sclerosis and stroke.
  
  
  RESULTS
  Results show that the regional variation in treatment of spasticity with BoNT-A is large, with approximately every fourth patient being treated in Southern healthcare region compared to every tenth in the Stockholm-Gotland or Western healthcare regions. The incremental cost of filling the reported treatment gap was also assessed and was estimated at around 9.4 million EUR. However, for the incremental cost to be offset by savings in spasticity-related costs, only a small proportion of treatment responders (defined as patients transitioning to a lower severity grade of spasticity) was required (12%).
  
  
  CONCLUSIONS
  The study revealed apparent regional disparities of BoNT-A treatment for spasticity in Sweden. The results further suggest that the incremental cost of eliminating the treatment gap has a high probability of being offset by savings in direct costs, even at a low proportion of the patients reaching clinical improvement.
authors.affiliation: Department of Rehabilitation Medicine and Department of Medicine and Health Sciences (IMH), Linköping University Hospital, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Ertzgaard
authors.affiliation: Ipsen, Kista, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Anhammer
authors.affiliation: Nordic Health Economics AB, Göteborg, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Forsmark
mesh_terms: D019274:Botulinum Toxins, Type A / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D009128:Muscle Spasticity / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D009465:Neuromuscular Agents / Q000191:economics / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data*; D013548:Sweden / Q000453:epidemiology
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: botulinum toxins; costs and cost analysis; muscle spasticity; regional variation