Cost-effectiveness of treating upper limb spasticity due to stroke with botulinum toxin type A: results from the botulinum toxin for the upper limb after stroke (BoTULS) trial

Phil Shackley*, Lisa Shaw, Christopher Price, Frederike van Wijck, Michael Barnes, Laura Graham, Gary A. Ford, Nick Steen, Helen Rodgers

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Stroke imposes significant burdens on health services and society, and as such there is a growing need to assess the cost-effectiveness of stroke treatment to ensure maximum benefit is derived from limited resources. This study compared the cost-effectiveness of treating post-stroke upper limb spasticity with botulinum toxin type A plus an upper limb therapy programme against the therapy programme alone. Data on resource use and health outcomes were prospectively collected for 333 patients with post-stroke upper limb spasticity taking part in a randomized trial and combined to estimate the incremental cost per quality adjusted life year (QALY) gained of botulinum toxin type A plus therapy relative to therapy alone. The base case incremental cost-effectiveness ratio (ICER) of botulinum toxin type A plus therapy was £93,500 per QALY gained. The probability of botulinum toxin type A plus therapy being cost-effective at the England and Wales cost-effectiveness threshold value of £20,000 per QALY was 0.36. The point estimates of the ICER remained above £20,000 per QALY for a range of sensitivity analyses, and the probability of botulinum toxin type A plus therapy being cost-effective at the threshold value did not exceed 0.39, regardless of the assumptions made.

Original languageEnglish
Pages (from-to)1415-26
Number of pages12
JournalToxins
Volume4
Issue number12
DOIs
Publication statusPublished - 27 Nov 2012

Keywords

  • botulinum toxins type A/administration & dosage
  • combined modality therapy
  • cost-benefit analysis
  • upper limb spasticity
  • muscle spasticity/economics
  • physical therapy modalities
  • quality-adjusted life years
  • stroke/complications
  • upper extremity
  • cost-effectiveness

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