Botulinum toxin type A for the treatment of patients with post-stroke spasticity in Thailand: cost-utility and budget impact analysis
Issued Date
2025-01-06
Resource Type
eISSN
20446055
Scopus ID
2-s2.0-85214534845
Journal Title
BMJ Open
Volume
15
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMJ Open Vol.15 No.1 (2025)
Suggested Citation
Hadnorntun P., Prawjaeng J., Kongmalai T., Tanvijit P., Chueluecha C., Jintakul N., Saringcarinkul T., Srinonprasert V., Kumthornthip W., Leelahavarong P. Botulinum toxin type A for the treatment of patients with post-stroke spasticity in Thailand: cost-utility and budget impact analysis. BMJ Open Vol.15 No.1 (2025). doi:10.1136/bmjopen-2024-090701 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/102796
Title
Botulinum toxin type A for the treatment of patients with post-stroke spasticity in Thailand: cost-utility and budget impact analysis
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Abstract
Objectives To evaluate the cost-utility of botulinum toxin A (BoNT-A) for treating upper limb (UL) and lower limb (LL) post-stroke spasticity. Design Using a Markov model, adopting a societal perspective and a lifetime horizon with a 3% annual discount rate, the cost-utility analysis was conducted to compare BoNT-A combined with standard of care (SoC) with SoC alone. Costs, utilities, transitional probabilities and treatment efficacy were derived from 5-year retrospective data from tertiary hospitals and meta-analysis. Uncertainty analyses were performed. Setting Tertiary hospitals in Thailand. Participants Cohort of post-stroke patients aged 55 years with UL or LL spasticity and a Modified Ashworth Scale score ≥1+. Interventions BoNT-A (abobotulinumtoxinA: aboBoNT-A, onabotulinumtoxinA: onaBoNT-A or prabotulinumtoxinA: praBoNT-A) combined with SoC versus SoC alone. Primary outcome measures Expected life years, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratios (ICERs), considering a cost-effectiveness threshold of 160 000 THB (US$4468) per QALY gained. Results The combination of aboBoNT-A and SoC yielded the highest QALYs gained (0.013 for UL and 0.11 for LL), followed by onaBoNT-A and SoC and praBoNT-A and SoC. The additional costs for treating UL and LL cases were highest for onaBoNT-A US$75 and US$95, respectively, followed by aboBoNT-A and praBoNT-A. ICER values for treating UL with aboBoNT-A, onaBoNT-A and praBoNT-A ranged from US$4669 to US$7541 per QALY. For LL treatments, aboBoNT-A and onaBoNT-A had ICER values ranging from US$7072 to US$15 182 per QALY. Integrating BoNT-A treatment delivery into the healthcare system would require a budget outlay of approximately US$413 246-US$966 103 that may vary annually by an additional US$50 260-US$335 064. Conclusion BoNT-A effectively reduces focal spasticity and improves quality of life in post-stroke patients. However, its cost-effectiveness in Thailand necessitates price negotiations as a condition for inclusion in the pharmaceutical reimbursement list.