AbobotulinumtoxinA and rehabilitation vs rehabilitation alone in post-stroke spasticity: An cost-utility analysis

Lazzaro, Carlo; Baricich, Alessio; Picelli, Alessandro; Caglioni, Patrizia Maria; Ratti, Marco; Santamato, Andrea

doi:10.2340/16501977-2636

Cited by 11 publications

(22 citation statements)

References 21 publications

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“…An important and widely debated issue concerns the cost-utility of BTX-A compared to the benefit gained, particularly in treating post-stroke spasticity. Investigations have demonstrated that aboBTX-A adjunct to rehabilitation produces a higher number of quality-adjusted life years compared to rehabilitation alone either in treating ULS [79] or post-stroke spasticity [80], and this therapeutic approach might be a cost-effective healthcare program for treating these patients [80]. In the present review, none of the studies included reported the cost-effectiveness of high BTX-A injection in treating spasticity, regardless of the aetiology.…”

Section: Discussionmentioning

confidence: 79%

High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at?

Intiso

Simone

Bartolo³

et al. 2020

Toxins

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Spasticity is a common disabling disorder in adult subjects suffering from stroke, brain injury, multiple sclerosis (MS) and spinal cord injury (SCI). Spasticity may be a disabling symptom in people during rehabilitation and botulinum toxin type A (BTX-A) has become the first-line therapy for the local form. High BTX-A doses are often used in clinical practice. Advantages and limitations are debated and the evidence is unclear. Therefore, we analysed the efficacy, safety and evidence for BTX-A high doses. Studies published from January 1989 to February 2020 were retrieved from MEDLINE/PubMed, Embase, Cochrane Central Register. Only obabotulinumtoxinA (obaBTX-A), onabotulinumtoxinA (onaBTX-A), and incobotulinumtoxinA (incoBTX-A) were considered. The term “high dosage” indicated ≥ 600 U. Thirteen studies met the inclusion criteria. Studies had variable method designs, sample sizes and aims, with only two randomised controlled trials. IncoBTX-A and onaBTX-A were injected in three and eight studies, respectively. BTX-A high doses were used predominantly in treating post-stroke spasticity. No studies were retrieved regarding treating spasticity in MS and SCI. Dosage of BTX-A up to 840 U resulted efficacious and safety without no serious adverse events (AEs). Evidence is insufficient to recommend high BTX-A use in clinical practice, but in selected patients, the benefits of high dose BTX-A may be clinically acceptable.

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Section: Discussionmentioning

confidence: 79%

High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at?

Intiso

Simone

Bartolo³

et al. 2020

Toxins

View full text Add to dashboard Cite

show abstract

“…In terms of costs, analyses were made from the point of view of society, the health care system, or at the clinic level. A study in Italy comparing treatment with aboBoNT-A and rehabilitation vs. rehabilitation alone found an improvement of 0.47 QALY more in the aboBoNT-A group over a 2-year period [29]. However, another study carried out by Doan et al [27] only found an improvement of 0.107 over 5 years of treatment with usual care and onaBoNT-A.…”

Section: Resultsmentioning

confidence: 97%

Economics of dry needling and botulinum toxin type A for treatment of post-stroke spasticity: a review

Fernández-Sanchis

Pujol-Fuentes

Ruber

et al. 2022

Explor Neuroprot Ther

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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 treated with BTX-A or DN. As a result, 7 studies of BTX-A and 2 of DN were selected. Similarities were found in the outcomes used to assess the effectiveness of both treatments in most studies, with modifications of the Ashworth Scale [Modified Ashworth Scale (MAS)/Modified Modified Ashworth Scale (MMAS)] and quality-adjusted life year (QALY) being the main indicators of effectiveness. However, both the duration of the studies and the evaluation of costs were highly heterogeneous, making comparison difficult. In conclusion, both BTX-A and DN are cost-effective to treat spasticity in patients with stroke, but there is a need for comparative studies to make direct comparisons of cost-effectiveness with the most frequently used outcomes such as the MMAS and QALYs.

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“…The intervention reported cost savings of £27 per patient; nevertheless, these results were also not significant (95% CI 2455.13 to 401.34, P = .91). A total of 3 meditated therapy interventions [48][49][50] concluded that meditated therapy was more effective and cheaper than usual care with incremental costeffectiveness ratio (ICER) values ranging from £192 to £12 214 (costs converted to price year 2020 sterling prices).…”

Section: Resultsmentioning

confidence: 99%

Value of Nonpharmacological Interventions for People With an Acquired Brain Injury: A Systematic Review of Economic Evaluations

et al. 2022

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AbobotulinumtoxinA and rehabilitation vs rehabilitation alone in post-stroke spasticity: An cost-utility analysis

Cited by 11 publications

References 21 publications

High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at?

High Dosage of Botulinum Toxin Type A in Adult Subjects with Spasticity Following Acquired Central Nervous System Damage: Where Are We at?

Economics of dry needling and botulinum toxin type A for treatment of post-stroke spasticity: a review

Value of Nonpharmacological Interventions for People With an Acquired Brain Injury: A Systematic Review of Economic Evaluations

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