DIRECT HEALTHCARE COST BURDEN OF POST-STROKE SPASTICITY IN GREECE
Author(s)
Nikos Nomikos, MSc1, Kostas Athanasakis, PhD1, Panagiota Naoum, PhD1, Christos Eleftheriou, BSc, MASc, MBA, MSc, PhD2, Apostolos Nitsas, MSc2, Eythimios Dardiotis, PhD3, Yannis Dionyssiotis, PhD4, Theodoros Karapanayiotides, PhD5, Spyridon Konitsiotis, PhD6, Konstantina Petropoulou, PhD7, Nikos Roussos, MD8, Jobst Rudolf, PhD9, Eleftherios Stefas, MD, MSc10, Aikaterini Terzoudi, PhD11.
1Laboratory for Health Technology Assessment – LabHTA, Dept. of Public Health Policy, University of West Attica, Athens, Greece, 2Ipsen Greece, Cyprus & Israel, Athens, Greece, 3Department of Neurology, University General Hospital of Larisa, Larisa, Greece, 42nd Physical Medicine and Rehabilitation Department, National Rehabilitation Center (EKA), Athens, Greece, 52nd Department of Neurology, School of Medicine / AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece, 6Department of Neurology, University of Ioannina, Ioannina, Greece, 7Physical Medicine & Rehabilitation Center “Attica”, Athens, Greece, 8PRM Department, Asklepieion Hospital, Athens, Greece, 9Department of Neurology, General Hospital Papageorgiou, Thessaloniki, Greece, 10School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, 11Neurology Department, School of Medicine, Democritus University of Thrace, Alexandroupoli, Greece.
1Laboratory for Health Technology Assessment – LabHTA, Dept. of Public Health Policy, University of West Attica, Athens, Greece, 2Ipsen Greece, Cyprus & Israel, Athens, Greece, 3Department of Neurology, University General Hospital of Larisa, Larisa, Greece, 42nd Physical Medicine and Rehabilitation Department, National Rehabilitation Center (EKA), Athens, Greece, 52nd Department of Neurology, School of Medicine / AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece, 6Department of Neurology, University of Ioannina, Ioannina, Greece, 7Physical Medicine & Rehabilitation Center “Attica”, Athens, Greece, 8PRM Department, Asklepieion Hospital, Athens, Greece, 9Department of Neurology, General Hospital Papageorgiou, Thessaloniki, Greece, 10School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece, 11Neurology Department, School of Medicine, Democritus University of Thrace, Alexandroupoli, Greece.
OBJECTIVES: To estimate the 10-year direct healthcare costs of post-stroke spasticity (PSS) in Greece from a third-party payer perspective.
METHODS: A model-based cost-of-illness analysis was conducted over a 10-year horizon. The model incorporated prevalent and incident PSS cases, stratified by time since onset and severity (mild, moderate, severe), with reference to Ashworth grading. Treatment pathways included oral antispasticity medications, botulinum toxin type A (BoNT-A) cycles, and rehabilitation services, including inpatient and outpatient rehabilitation programs and individual physiotherapy, occupational therapy, and speech therapy sessions. National data, published literature, and a structured expert panel informed epidemiological, severity-distribution, and resource-use inputs. Costs were valued in 2025 euros and discounted at 3.5%.
RESULTS: At baseline, the model included 65,989 prevalent PSS cases, with 18,848 incident cases entering the model in year 1. The cumulative direct healthcare cost of PSS over 10 years was estimated at €3.40 billion. Costs were concentrated in the early years: mean annual cost per patient was €7,035 in year 1, declining to €2,293 by year 10, mainly due to reduced rehabilitation intensity over time. Rehabilitation services accounted for 71.3% of total costs, followed by pharmacological management, including oral antispasticity medications and BoNT-A drug acquisition and administration costs (27.4%), while medical follow-up and surgical procedures contributed 0.8% and 0.5%, respectively. Severe cases accounted for 48.7% of total expenditure, followed by moderate (39.9%) and mild cases (11.4%). Over time, the relative contribution of pharmacological management increased as rehabilitation intensity declined. One-way deterministic sensitivity analysis indicated that uncertainty in key parameters did not alter the conclusion that PSS imposes a substantial long-term economic burden.
CONCLUSIONS: PSS represents a substantial direct healthcare burden for the Greek healthcare system, driven by early rehabilitation needs and severe disease. These findings provide a baseline for evidence-based resource allocation and the development of integrated care pathways in Greece.
METHODS: A model-based cost-of-illness analysis was conducted over a 10-year horizon. The model incorporated prevalent and incident PSS cases, stratified by time since onset and severity (mild, moderate, severe), with reference to Ashworth grading. Treatment pathways included oral antispasticity medications, botulinum toxin type A (BoNT-A) cycles, and rehabilitation services, including inpatient and outpatient rehabilitation programs and individual physiotherapy, occupational therapy, and speech therapy sessions. National data, published literature, and a structured expert panel informed epidemiological, severity-distribution, and resource-use inputs. Costs were valued in 2025 euros and discounted at 3.5%.
RESULTS: At baseline, the model included 65,989 prevalent PSS cases, with 18,848 incident cases entering the model in year 1. The cumulative direct healthcare cost of PSS over 10 years was estimated at €3.40 billion. Costs were concentrated in the early years: mean annual cost per patient was €7,035 in year 1, declining to €2,293 by year 10, mainly due to reduced rehabilitation intensity over time. Rehabilitation services accounted for 71.3% of total costs, followed by pharmacological management, including oral antispasticity medications and BoNT-A drug acquisition and administration costs (27.4%), while medical follow-up and surgical procedures contributed 0.8% and 0.5%, respectively. Severe cases accounted for 48.7% of total expenditure, followed by moderate (39.9%) and mild cases (11.4%). Over time, the relative contribution of pharmacological management increased as rehabilitation intensity declined. One-way deterministic sensitivity analysis indicated that uncertainty in key parameters did not alter the conclusion that PSS imposes a substantial long-term economic burden.
CONCLUSIONS: PSS represents a substantial direct healthcare burden for the Greek healthcare system, driven by early rehabilitation needs and severe disease. These findings provide a baseline for evidence-based resource allocation and the development of integrated care pathways in Greece.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE359
Topic
Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Neurological Disorders