The Overlooked Need for Modeling Beyond Reimbursement to Support Therapy Uptake: Case Study of Botulinum Toxin for Spasticity Treatment
Author(s)
Adam Evens, MBio1, Maria Rapoport, MSc1, James Harris, PhD2, Astrid Scheschonka, Dr. Med.3, Georg-Alexander Pietsch, MSc3, Henrik Evers, MSc3.
1Wickenstones Ltd, Oxford, United Kingdom, 2Wickenstones Ltd, Carlow, Ireland, 3Merz Therapeutics GmbH, Frankfurt am Main, Germany.
1Wickenstones Ltd, Oxford, United Kingdom, 2Wickenstones Ltd, Carlow, Ireland, 3Merz Therapeutics GmbH, Frankfurt am Main, Germany.
OBJECTIVES: Botulinum toxin (BoNT) is an effective, approved, guideline-indicated and reimbursed treatment for focal spasticity, yet few eligible patients receive it. This underuse contributes to higher healthcare resource use, worse quality of life and an increased caregiver burden.1,2 Beyond reimbursement, real-world delivery of BoNT requires investment in provider training and efficient care pathways. We conducted a systematised literature review to examine how BoNT’s health-economic impacts have been characterised and what evidence gaps remain.
METHODS: We searched MEDLINE and Embase for reports published in 2010-2025 describing economic outcomes of BoNT use for spasticity.
RESULTS: The review identified 51 relevant records, including 25 economic models, 22 economic reports and 4 country-level guidelines. Of the 25 economic models, 11 compared BoNT with a standard of care comparator, with a focus on cost outcomes. Only 3 of 11 models considered a societal perspective and only one model each included productivity loss, transportation, out-of-pocket expenses and need for private carers. Five models included caregiver time costs. None focused on the economic impacts of BoNT implementation on healthcare stakeholders other than payers. Existing models were limited by data availability and often used outdated or sub-optimally fitting inputs.
CONCLUSIONS: Most existing models adopt a narrow payer perspective and insufficiently account for broader societal impacts of BoNT use. Important evidence gaps remain in capturing societal consequences and costs borne by stakeholders beyond healthcare payers. Our findings highlight the need for more comprehensive modelling that goes beyond reimbursement decisions to include outcomes relevant to patients, caregivers, healthcare providers, policy and clinical decision makers. Such analyses can support informed decision making and help demonstrate how integrating BoNT into the care pathway could enhance care efficiency for patients with focal spasticity.
1. Esquenazi A et al. J Rehabil Med. 2023;55:jrm11626. doi:10.2340/jrm.v55.11626 2. Bhakta BB et al. J Neurol Neurosurg Psychiatry. 2000;69(2):217-221. doi:10.1136/jnnp.69.2.217
METHODS: We searched MEDLINE and Embase for reports published in 2010-2025 describing economic outcomes of BoNT use for spasticity.
RESULTS: The review identified 51 relevant records, including 25 economic models, 22 economic reports and 4 country-level guidelines. Of the 25 economic models, 11 compared BoNT with a standard of care comparator, with a focus on cost outcomes. Only 3 of 11 models considered a societal perspective and only one model each included productivity loss, transportation, out-of-pocket expenses and need for private carers. Five models included caregiver time costs. None focused on the economic impacts of BoNT implementation on healthcare stakeholders other than payers. Existing models were limited by data availability and often used outdated or sub-optimally fitting inputs.
CONCLUSIONS: Most existing models adopt a narrow payer perspective and insufficiently account for broader societal impacts of BoNT use. Important evidence gaps remain in capturing societal consequences and costs borne by stakeholders beyond healthcare payers. Our findings highlight the need for more comprehensive modelling that goes beyond reimbursement decisions to include outcomes relevant to patients, caregivers, healthcare providers, policy and clinical decision makers. Such analyses can support informed decision making and help demonstrate how integrating BoNT into the care pathway could enhance care efficiency for patients with focal spasticity.
1. Esquenazi A et al. J Rehabil Med. 2023;55:jrm11626. doi:10.2340/jrm.v55.11626 2. Bhakta BB et al. J Neurol Neurosurg Psychiatry. 2000;69(2):217-221. doi:10.1136/jnnp.69.2.217
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE719
Topic
Economic Evaluation, Health Policy & Regulatory, Study Approaches
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Work & Home Productivity - Indirect Costs
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Neurological Disorders