Botulinum toxin type A in the management of equinus in children with cerebral palsy: an evidence-based economic evaluation

Houltram, J., Noble, I., Boyd, R. N., Corry, I., Flett, P. and Graham, H. K. (2001). Botulinum toxin type A in the management of equinus in children with cerebral palsy: an evidence-based economic evaluation. In: Meeting on Clinical Considerations for the Therapeutic Use of Botulinum Toxin Type-A in Cerebral Palsy: an Evidence-Based Examination, Lake Maggiore, Italy, (194-202). June 2000. doi:10.1046/j.1468-1331.2001.00052.x


Author Houltram, J.
Noble, I.
Boyd, R. N.
Corry, I.
Flett, P.
Graham, H. K.
Title of paper Botulinum toxin type A in the management of equinus in children with cerebral palsy: an evidence-based economic evaluation
Conference name Meeting on Clinical Considerations for the Therapeutic Use of Botulinum Toxin Type-A in Cerebral Palsy: an Evidence-Based Examination
Conference location Lake Maggiore, Italy
Conference dates June 2000
Journal name European Journal of Neurology   Check publisher's open access policy
Place of Publication Oxford, United Kingdom
Publisher Wiley-Blackwell
Publication Year 2001
Sub-type Fully published paper
DOI 10.1046/j.1468-1331.2001.00052.x
ISSN 1351-5101
1468-1331
Volume 8
Issue Supplement 5
Start page 194
End page 202
Total pages 8
Language eng
Formatted Abstract/Summary
Introduction: The aim of this study was to compare two methods of conservative management of calf spasticity and equinus gait – intramuscular injection of botulinum toxin type A (BTX-A) and serial casting. An economic evaluation framework was adopted to assess whether BTX-A offers value for money in the management of equinus gait due to calf spasticity in children with cerebral palsy. Short- to medium-term health care costs and outcomes were estimated for the comparison. This study was embarked upon to provide clinical and economic data as part of an application to the Pharmaceutical Benefits Advisory Committee (PBAC) for the reimbursement of BOTOX® by the Australian Commonwealth Government. This is the primary mechanism for reimbursement of pharmaceuticals in Australia, as they are not routinely reimbursed through health insurance companies. The perspective of the analysis was that of the Australian health system.

Methodology: Randomized controlled trials (RCTs) exist comparing one treatment cycle of BTX-A with serial casting (Corry et al., 1998; Flett et al., 1999). A long-term prospective study provided data on multiple cycles of BTX-A treatment in a more naturalistic setting (Boyd et al., 1999). A simple economic modelling approach was used to establish resource utilization by treatment arm. Only direct medical costs were considered (BTX-A, medical personnel time and medical consumables).

Main measures: Clinical efficacy was obtained from the randomized controlled trials (Corry et al., 1998; Flett et al., 1999). Patient/parent preference was obtained from long-term follow-up (Corry et al., 1998) and a preference questionnaire (Flett et al., 1999). Australian treatment patterns and patient demographics were obtained from the naturalistic study (Boyd et al., 1999).

Results: The RCTs demonstrated equivalent efficacy of BTX-A and serial casting; however, with BTX-A the effect lasted longer and was clearly the preferred treatment. For patients with hemiplegia the costs of an episode of treatment with BTX-A or serial casting are ($AUD) $595 and $435, respectively, and thus the additional costs associated with BTX-A are $160. The corresponding costs for patients with diplegia are $1045 for BTX-A treatment and $870 for serial casting and thus the additional cost associated with BTX-A is $175. With an overall treatment duration of 3.7 years and an average treatment interval of 10 months, patients would receive an average of 5.4 treatments. Thus, for patients with hemiplegia the total additional cost, discounted at 5% annually, for BTX-A is $793. For patients with diplegia the total additional cost for BTX-A is $867.

Conclusions and clinical interpretations: BTX-A is an effective, safe and acceptable treatment modality and is associated with only a modest increase in direct medical costs per child per year. BTX-A can be considered a valuable and cost-effective treatment in the conservative management of equinus due to calf spasticity in children with cerebral palsy. This conclusion is supported by the acceptance of the Pharmaceutical Benefits Advisory Committee (PBAC) recommendation that BOTOX® should attract a full Government subsidy in Australia.
Keyword Botulinum A
Cerebral palsy
Economic evaluation
Equinus
Q-Index Code E1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Conference Paper
Collection: School of Medicine Publications
 
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Created: Thu, 10 Mar 2011, 20:16:55 EST