Botulinum Toxin Type A for the Treatment of Patients with Post-stroke Spasticity in Thailand: Cost-utility and Budget Impact Analysis

Overview

Journal BMJ Open

Specialty General Medicine

Date 2025 Jan 6

PMID 39762094

Authors

Phorntida Hadnorntun

Juthamas Prawjaeng

Tanawan Kongmalai

Phakamas Tanvijit

Chuenchom Chueluecha

Nawarat Jintakul

Tipyarat Saringcarinkul

Varalak Srinonprasert

Witsanu Kumthornthip

Pattara Leelahavarong

Affiliations

Soon will be listed here.

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.

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