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• Shackley, P
• Shaw, L
• Price, C
• Wijck, Fvan
• Barnes, M
• Graham, L
• Ford, GA.
• Steen, N
• Rodgers, H
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• Shackley, P
• Shaw, L
• Price, C
• Wijck, Fvan
• Barnes, M
• Graham, L
• Ford, GA.
• Steen, N
• Rodgers, H
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• Shackley, P
• Shaw, L
• Price, C
• Wijck, Fvan
• Barnes, M
• Graham, L
• Ford, GA.
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Toxins 2012, 4(12), 1415-1426; doi:10.3390/toxins4121415

Article

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 ^1,* , Lisa Shaw ², Christopher Price ², Frederike van Wijck ³, Michael Barnes ⁴, Laura Graham ⁴, Gary A. Ford ², Nick Steen ⁵ and Helen Rodgers ²

¹ School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK ² Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne NE4 5PL, UK ³ Institute for Applied Health Research, School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow G4 0BA, UK ⁴ International Centre for Neurorehabilitation, Walkergate Park, Benfield Road, Newcastle upon Tyne NE6 4QD, UK ⁵ Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE2 4AA, UK

* Author to whom correspondence should be addressed.

Received: 30 August 2012; in revised form: 12 November 2012 / Accepted: 21 November 2012 / Published: 27 November 2012

(This article belongs to the Special Issue Clinical Use of Botulinum Toxins)

Download PDF Full-Text [273 KB, uploaded 27 November 2012 15:13 CET]

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.

Keywords: botulinum toxin type A; stroke; upper limb spasticity; cost-effectiveness

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