Cargando…

Cost Effectiveness of Long-Term Incobotulinumtoxin-A Treatment in the Management of Post-stroke Spasticity of the Upper Limb from the Australian Payer Perspective

BACKGROUND: In Australia, the reimbursement of botulinum neurotoxin-A (BoNT-A) on the Pharmaceutical Benefits Scheme for the treatment of moderate to severe spasticity of the upper limb following a stroke (PSS-UL) is restricted to four treatment cycles per upper limb per lifetime. This analysis exam...

Descripción completa

Detalles Bibliográficos
Autores principales: Makino, Koji, Tilden, Dominic, Guarnieri, Carmel, Mudge, Mia, Baguley, Ian J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393278/
https://www.ncbi.nlm.nih.gov/pubmed/29915932
http://dx.doi.org/10.1007/s41669-018-0086-z
_version_ 1783398651791409152
author Makino, Koji
Tilden, Dominic
Guarnieri, Carmel
Mudge, Mia
Baguley, Ian J.
author_facet Makino, Koji
Tilden, Dominic
Guarnieri, Carmel
Mudge, Mia
Baguley, Ian J.
author_sort Makino, Koji
collection PubMed
description BACKGROUND: In Australia, the reimbursement of botulinum neurotoxin-A (BoNT-A) on the Pharmaceutical Benefits Scheme for the treatment of moderate to severe spasticity of the upper limb following a stroke (PSS-UL) is restricted to four treatment cycles per upper limb per lifetime. This analysis examined the cost effectiveness of extending the treatment beyond four treatments among patients with an adequate response to previous treatment cycles. METHODS: A Markov state transition model was developed to perform a cost-utility analysis of extending the use of incobotulinumtoxin-A beyond the current restriction of four treatment cycles among patients who have shown a successful response in previous treatment cycles (’known responders’). The Markov model followed patients in 12-weekly cycles for 5 years, estimating the proportion of patients with or without response over this period in each of the modelled treatment arms. Post hoc analysis of an open-label extension phase study informed the Markov model. The perspective of the analysis was the Australian healthcare system, meaning only direct healthcare costs were included. Utility values by response status were derived from EQ-5D data from a published double-blind, placebo-controlled study. The primary outcome measure was the incremental cost per quality-adjusted life-year (QALY). Univariate and probabilistic sensitivity analyses were conducted. RESULTS: The open-label extension study data demonstrated the probability of treatment response after four injections was greater among ‘known responders’ than those without prior response. The incremental cost per QALY gained of continued use of incobotulinumtoxin-A beyond the current restriction of four treatments was A$59,911. CONCLUSION: Limiting BoNT-A treatment to four cycles per patient per lifetime is likely to be suboptimal in many patients with PSS-UL. Treatment response beyond four cycles is highest among known responders, and allowing such patients to continue treatment beyond four cycles appears cost effective.
format Online
Article
Text
id pubmed-6393278
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher Springer International Publishing
record_format MEDLINE/PubMed
spelling pubmed-63932782019-03-15 Cost Effectiveness of Long-Term Incobotulinumtoxin-A Treatment in the Management of Post-stroke Spasticity of the Upper Limb from the Australian Payer Perspective Makino, Koji Tilden, Dominic Guarnieri, Carmel Mudge, Mia Baguley, Ian J. Pharmacoecon Open Original Research Article BACKGROUND: In Australia, the reimbursement of botulinum neurotoxin-A (BoNT-A) on the Pharmaceutical Benefits Scheme for the treatment of moderate to severe spasticity of the upper limb following a stroke (PSS-UL) is restricted to four treatment cycles per upper limb per lifetime. This analysis examined the cost effectiveness of extending the treatment beyond four treatments among patients with an adequate response to previous treatment cycles. METHODS: A Markov state transition model was developed to perform a cost-utility analysis of extending the use of incobotulinumtoxin-A beyond the current restriction of four treatment cycles among patients who have shown a successful response in previous treatment cycles (’known responders’). The Markov model followed patients in 12-weekly cycles for 5 years, estimating the proportion of patients with or without response over this period in each of the modelled treatment arms. Post hoc analysis of an open-label extension phase study informed the Markov model. The perspective of the analysis was the Australian healthcare system, meaning only direct healthcare costs were included. Utility values by response status were derived from EQ-5D data from a published double-blind, placebo-controlled study. The primary outcome measure was the incremental cost per quality-adjusted life-year (QALY). Univariate and probabilistic sensitivity analyses were conducted. RESULTS: The open-label extension study data demonstrated the probability of treatment response after four injections was greater among ‘known responders’ than those without prior response. The incremental cost per QALY gained of continued use of incobotulinumtoxin-A beyond the current restriction of four treatments was A$59,911. CONCLUSION: Limiting BoNT-A treatment to four cycles per patient per lifetime is likely to be suboptimal in many patients with PSS-UL. Treatment response beyond four cycles is highest among known responders, and allowing such patients to continue treatment beyond four cycles appears cost effective. Springer International Publishing 2018-06-18 /pmc/articles/PMC6393278/ /pubmed/29915932 http://dx.doi.org/10.1007/s41669-018-0086-z Text en © The Author(s) 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Research Article
Makino, Koji
Tilden, Dominic
Guarnieri, Carmel
Mudge, Mia
Baguley, Ian J.
Cost Effectiveness of Long-Term Incobotulinumtoxin-A Treatment in the Management of Post-stroke Spasticity of the Upper Limb from the Australian Payer Perspective
title Cost Effectiveness of Long-Term Incobotulinumtoxin-A Treatment in the Management of Post-stroke Spasticity of the Upper Limb from the Australian Payer Perspective
title_full Cost Effectiveness of Long-Term Incobotulinumtoxin-A Treatment in the Management of Post-stroke Spasticity of the Upper Limb from the Australian Payer Perspective
title_fullStr Cost Effectiveness of Long-Term Incobotulinumtoxin-A Treatment in the Management of Post-stroke Spasticity of the Upper Limb from the Australian Payer Perspective
title_full_unstemmed Cost Effectiveness of Long-Term Incobotulinumtoxin-A Treatment in the Management of Post-stroke Spasticity of the Upper Limb from the Australian Payer Perspective
title_short Cost Effectiveness of Long-Term Incobotulinumtoxin-A Treatment in the Management of Post-stroke Spasticity of the Upper Limb from the Australian Payer Perspective
title_sort cost effectiveness of long-term incobotulinumtoxin-a treatment in the management of post-stroke spasticity of the upper limb from the australian payer perspective
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6393278/
https://www.ncbi.nlm.nih.gov/pubmed/29915932
http://dx.doi.org/10.1007/s41669-018-0086-z
work_keys_str_mv AT makinokoji costeffectivenessoflongtermincobotulinumtoxinatreatmentinthemanagementofpoststrokespasticityoftheupperlimbfromtheaustralianpayerperspective
AT tildendominic costeffectivenessoflongtermincobotulinumtoxinatreatmentinthemanagementofpoststrokespasticityoftheupperlimbfromtheaustralianpayerperspective
AT guarniericarmel costeffectivenessoflongtermincobotulinumtoxinatreatmentinthemanagementofpoststrokespasticityoftheupperlimbfromtheaustralianpayerperspective
AT mudgemia costeffectivenessoflongtermincobotulinumtoxinatreatmentinthemanagementofpoststrokespasticityoftheupperlimbfromtheaustralianpayerperspective
AT baguleyianj costeffectivenessoflongtermincobotulinumtoxinatreatmentinthemanagementofpoststrokespasticityoftheupperlimbfromtheaustralianpayerperspective