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
by
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
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.
Toxins 2012, 4(12), 1415-1426; https://doi.org/10.3390/toxins4121415
Received: 30 August 2012 / Revised: 12 November 2012 / Accepted: 21 November 2012 / Published: 27 November 2012
(This article belongs to the Special Issue Clinical Use of Botulinum Toxins)
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.
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MDPI and ACS Style
Shackley, P.; Shaw, L.; Price, C.; Wijck, F.V.; Barnes, M.; Graham, L.; Ford, G.A.; Steen, N.; Rodgers, H. 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. Toxins 2012, 4, 1415-1426.
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