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Inequalities in pharmacologic treatment of spasticity in Sweden – health economic consequences of closing the treatment gap
BACKGROUND: The Swedish Healthcare Act states that patients should have equal access to healthcare. This study addresses at how this translates to pharmacological treatment of adult spasticity, including injections with botulinum toxin A (BoNT-A) and pumps for intrathecal baclofen (ITB). To address...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006187/ https://www.ncbi.nlm.nih.gov/pubmed/32030530 http://dx.doi.org/10.1186/s13561-020-0261-7 |
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author | Forsmark, Annabelle Rosengren, Linda Ertzgaard, Per |
author_facet | Forsmark, Annabelle Rosengren, Linda Ertzgaard, Per |
author_sort | Forsmark, Annabelle |
collection | PubMed |
description | BACKGROUND: The Swedish Healthcare Act states that patients should have equal access to healthcare. This study addresses at how this translates to pharmacological treatment of adult spasticity, including injections with botulinum toxin A (BoNT-A) and pumps for intrathecal baclofen (ITB). To address potential economic incentives for treatment differences, the results are also set into a health economic perspective. Thus, the current study provides a detailed and comprehensive overview for informed decision- and policymaking. METHODS: Botulinum toxin use was retrieved from sales data. Clinical practice regarding mean BoNT-A treatment dose and proportion used for spasticity indication were validated in five county councils, while the number of ITB pumps were mapped for all county councils. Published costs and quality of life data was used for estimating required responder rates for cost-balance or cost-effectiveness. RESULTS: The proportion of patients treated with BoNT-A varied between 5.8% and 13.6% across healthcare regions, with a mean of 9.2% on a national level. The reported number of ITB pumps per 100,000 inhabitants varied between 3.6 and 14.1 across healthcare regions, with a national mean of 6/100,000. The estimated incremental cost for reaching treatment equity was EUR 1,976,773 per year for BoNT-A and EUR 3,326,692 for ITB pumps. Based on expected cost-savings, responder rates ranging between 4% and 15% cancelled out the incremental cost for BoNT-A. Assuming no cost-savings, responder rates of 14% or 36% was required for cost-effectiveness. CONCLUSIONS: There is a marked variation in pharmacologic treatment of adult spasticity in Sweden. Overall, the results indicate an underuse of treatment and need for harmonisation of clinical practice. Furthermore, the incremental cost for reaching treatment equity is likely to be offset by spasticity-associated cost-savings. |
format | Online Article Text |
id | pubmed-7006187 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-70061872020-02-11 Inequalities in pharmacologic treatment of spasticity in Sweden – health economic consequences of closing the treatment gap Forsmark, Annabelle Rosengren, Linda Ertzgaard, Per Health Econ Rev Research BACKGROUND: The Swedish Healthcare Act states that patients should have equal access to healthcare. This study addresses at how this translates to pharmacological treatment of adult spasticity, including injections with botulinum toxin A (BoNT-A) and pumps for intrathecal baclofen (ITB). To address potential economic incentives for treatment differences, the results are also set into a health economic perspective. Thus, the current study provides a detailed and comprehensive overview for informed decision- and policymaking. METHODS: Botulinum toxin use was retrieved from sales data. Clinical practice regarding mean BoNT-A treatment dose and proportion used for spasticity indication were validated in five county councils, while the number of ITB pumps were mapped for all county councils. Published costs and quality of life data was used for estimating required responder rates for cost-balance or cost-effectiveness. RESULTS: The proportion of patients treated with BoNT-A varied between 5.8% and 13.6% across healthcare regions, with a mean of 9.2% on a national level. The reported number of ITB pumps per 100,000 inhabitants varied between 3.6 and 14.1 across healthcare regions, with a national mean of 6/100,000. The estimated incremental cost for reaching treatment equity was EUR 1,976,773 per year for BoNT-A and EUR 3,326,692 for ITB pumps. Based on expected cost-savings, responder rates ranging between 4% and 15% cancelled out the incremental cost for BoNT-A. Assuming no cost-savings, responder rates of 14% or 36% was required for cost-effectiveness. CONCLUSIONS: There is a marked variation in pharmacologic treatment of adult spasticity in Sweden. Overall, the results indicate an underuse of treatment and need for harmonisation of clinical practice. Furthermore, the incremental cost for reaching treatment equity is likely to be offset by spasticity-associated cost-savings. Springer Berlin Heidelberg 2020-02-07 /pmc/articles/PMC7006187/ /pubmed/32030530 http://dx.doi.org/10.1186/s13561-020-0261-7 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted 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 | Research Forsmark, Annabelle Rosengren, Linda Ertzgaard, Per Inequalities in pharmacologic treatment of spasticity in Sweden – health economic consequences of closing the treatment gap |
title | Inequalities in pharmacologic treatment of spasticity in Sweden – health economic consequences of closing the treatment gap |
title_full | Inequalities in pharmacologic treatment of spasticity in Sweden – health economic consequences of closing the treatment gap |
title_fullStr | Inequalities in pharmacologic treatment of spasticity in Sweden – health economic consequences of closing the treatment gap |
title_full_unstemmed | Inequalities in pharmacologic treatment of spasticity in Sweden – health economic consequences of closing the treatment gap |
title_short | Inequalities in pharmacologic treatment of spasticity in Sweden – health economic consequences of closing the treatment gap |
title_sort | inequalities in pharmacologic treatment of spasticity in sweden – health economic consequences of closing the treatment gap |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006187/ https://www.ncbi.nlm.nih.gov/pubmed/32030530 http://dx.doi.org/10.1186/s13561-020-0261-7 |
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