Botulinum toxin for people with dystonia treated by an outreach nurse practitioner: A comparative study between a home and a clinic treatment service

Whitaker, John J; Butler, Anthony; Semlyen, Joanna; Barnes, Michael P.

doi:10.1053/apmr.2001.21843

Cited by 28 publications

(20 citation statements)

References 3 publications

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“…All studies mentioned that the costs of BTX treatment for FD mainly consist of the costs of the toxin itself, since BTX is an expensive drug [4, 5, 7, 10, 13, 40]. Other cost drivers include for example material, personnel costs, and travel expenses [5].…”

Section: What Are the Costs Of Btx Treatment?mentioning

confidence: 99%

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Botulinum toxin as treatment for focal dystonia: a systematic review of the pharmaco-therapeutic and pharmaco-economic value

et al. 2012

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Focal dystonia is a common, invalidating neurologic condition characterized by involuntary, sustained muscle contractions causing twisting movements and abnormal postures in one body part. Currently, botulinum toxin is the treatment of first choice. We performed a systematic review towards the pharmaco-therapeutic and pharmaco-economic value of botulinum toxin as treatment for focal dystonia, which yielded the following results. Botulinum toxin is the most effective treatment for reducing dystonic symptoms measured with dystonia-specific and general questionnaires, and pain in patients with focal dystonia. Seventy-one percent of patients with cervical dystonia had a reduction in neck pain compared to 12 % in placebo groups. Adverse events occur in 58 % of patients during treatment with botulinum toxin compared to 46 % treated with placebo. Especially dry mouth, neck weakness, dysphagia, and voice changes are common. Adverse events are usually mild and self-limiting. Health-related quality of life, measured with the SF-36 is 20–50 points lower in patients with focal dystonia compared to controls and the effect of botulinum toxin on health-related quality of life is unclear. Botulinum toxin treatment is expensive because the drug itself is expensive. Yearly costs for treating a patient with focal dystonia with botulinum toxin range from EUR 347 to EUR 3,633 and the gain in QALYs with BTX treatment is small. Focal dystonia impairs the productivity and the ability to work. At start of botulinum toxin treatment only 47–50 % was working. Botulinum toxin partly improves this. Overall, we conclude that botulinum toxin is an expensive drug with good effects. From a societal perspective, the costs may well weigh up to the regained quality of life. However, the available literature concerning costs, health-related quality of life and labor participation is very limited. An extensive cost-effectiveness study should be performed incorporating all these aspects.Electronic supplementary materialThe online version of this article (doi:10.1007/s00415-012-6510-x) contains supplementary material, which is available to authorized users.

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Section: What Are the Costs Of Btx Treatment?mentioning

confidence: 99%

“…This was at least as effective and safe as treatment at the outpatient clinic, and was valued significantly higher by patients. The costs of the visit (excl the BTX) were halved, but the difference on total costs was not significant, since BTX was the main cost driver [40]. …”

Section: What Are the Costs Of Btx Treatment?mentioning

confidence: 99%

Botulinum toxin as treatment for focal dystonia: a systematic review of the pharmaco-therapeutic and pharmaco-economic value

et al. 2012

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“…One systematic review 4 included any qualified nurse working as substitute to a primary care physician such as nurse practitioner, practice nurse, health visitor, and others. In the other systematic review 5 and three RCTs, 6–8 general practice nurses were called nurse practitioners. In the remaining studies, nurses were called community nurse, 9,10 registered nurse, 11 or primary health‐care nurse 12…”

Section: Nurse‐led Care Vs Doctor‐led Carementioning

confidence: 99%

“…The patients studied in the two systematic reviews 4,5 were not specific about the type of health problem for which care was provided. All of the RCTs focused on patients with one type of health problem namely incontinence, 11 non‐emergent medical condition, 7 bronchiectasis, 6 Parkinson's disease, 9 dystonia, 8 mobility impairments or history of falls, 10 and excessive drinking 12…”

Section: Nurse‐led Care Vs Doctor‐led Carementioning

confidence: 99%

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Systematic review of the effectiveness of primary care nursing

Keleher

Parker

Abdulwadud

et al. 2009

Int J of Nursing Practice

119

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This paper reports on a systematic review that sought to answer the research question: What is the impact of the primary and community care nurse on patient health outcomes compared with usual doctor-led care in primary care settings? A range of pertinent text-words with medical subject headings were combined and electronic databases were searched. Because of the volume of published articles, the search was restricted to studies with high-level evidence. Overall, 31 relevant studies were identified and included in the review. We found modest international evidence that nurses in primary care settings can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors. Nurses are effective in care management and achieve good patient compliance. Nurses are also effective in a more diverse range of roles including chronic disease management, illness prevention and health promotion. Nevertheless, there is insufficient evidence about primary care nurses' roles and impact on patient health outcomes.

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