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- Title
Estimating the cost consequence of the early use of botulinum toxin in post-stroke spasticity: Secondary analysis of a randomised controlled trial.
- Authors
Lindsay, Cameron; Humphreys, Ioan; Phillips, Ceri; Pandyan, Anand
- Abstract
Objective: To estimate the cost-consequence of treating spasticity early with botulinum toxin in the acute stroke unit. Design: Secondary cost-consequence analysis, using data from a double-blind randomised-controlled trial. Setting: Single-centre specialised stroke unit. Subjects and Interventions: Patients with Action Research Arm Test grasp-score of <2 and who developed spasticity within six weeks of a first stroke were randomised to receive injections of: 0.9% sodium-chloride solution (placebo) or onabotulinumtoxin-A (treatment). Main measures: Resource use costs were calculated for the study. Mean contracture costs for each group were calculated. The Barthel Index and Action Research Arm Test were used to generate a cost per unit of improvement. Results: There were no significant differences associated with early treatment use. The mean contracture cost for the treatment group was £817 and for the control group was £2298 (mean difference = −£1481.1(95% CI −£2893.5, −£68.7) (p = 0.04). The cost per unit of improvement for the Barthel Index was −£1240 indicating that the intervention costs less and is more effective. The cost per unit of improvement for the Action Research Arm Test was −£450 indicating that the intervention costs less and is more effective. Conclusions: Treating spasticity early in stroke patients at risk of contractures with botulinum toxin leads to a significant reduction in contracture costs. The cost per improvement of Barthel and Action Research Arm Test indicates that the intervention costs less and is more effective. Trial Registration data: EudraCT(2010-021257-39) and ClinicalTrials.gov-Identifier:NCT01882556.
- Subjects
BOTULINUM toxin; CONFIDENCE intervals; MEDICAL care costs; SPASTICITY; STROKE units; STROKE patients; DESCRIPTIVE statistics; RESEARCH funding; DATA analysis software; BARTHEL Index; SECONDARY analysis
- Publication
Clinical Rehabilitation, 2023, Vol 37, Issue 3, p373
- ISSN
0269-2155
- Publication type
Article
- DOI
10.1177/02692155221133522