LIMITED USE OF BOTULINUM TOXIN IN POST-STROKE SPASTICITY IN BRAZIL: A REAL-WORLD ANALYSIS OF TREATMENT PATTERNS, COSTS, AND HEALTHCARE RESOURCE UTILIZATION (2016-2023)
Author(s)
Leandro L. Alves1, Juliana Sinohara, PhD2.
1HEOR & Pricing Sr Manager, Ipsen, São Paulo, Brazil, 2IPSEN, São Paulo, Brazil.
1HEOR & Pricing Sr Manager, Ipsen, São Paulo, Brazil, 2IPSEN, São Paulo, Brazil.
OBJECTIVES: In 2017, botulinum toxin (BT) became available through centralized federal distribution for post-stroke spasticity (PSS) in Brazil’s public healthcare system (SUS). This study describes real-world treatment patterns, patient journey, costs, and healthcare resource utilization (HRU) among patients with PSS in SUS, and compares outcomes between patients treated and not treated with BT.
METHODS: A retrospective cohort study used secondary administrative claims data from SUS. Patients with stroke (ICD-10 I61, I63, I64) and subsequent PSS-related diagnoses identified from 2016 to 2023 were included if they had at least 12 months of follow-up. Patients were grouped as BT-treated, non-pharmacological treatment, or no treatment. Descriptive analyses assessed treatment patterns, HRU, and direct medical costs from the public payer perspective.
RESULTS: Among 32,984 patients with PSS, only 5.2% received at least one BT injection within 12 months, while 94.8% did not. Non-pharmacological rehabilitation was common among untreated patients (84.2%), indicating reliance on supportive care. BT exposure was limited: 38.8% of treated patients received only one administration during 2016-2023. BT-treated patients had higher total annual costs per patient (BRL 5,470), but lower monthly costs (BRL 265) than untreated patients (BRL 573), suggesting more efficient long-term resource utilization. In the acute phase (urgent medical care), mean hospitalization cost was BRL 1,538 per patient, with regional variation. Monthly costs declined from BRL 638.11 before BT initiation to BRL 152.40 after treatment.
CONCLUSIONS: This real-world study highlights substantial unmet needs and inequities in PSS management in Brazil. Low BT use and limited persistency suggest barriers to access and care delivery. Descriptive differences in HRU and monthly costs were observed between treated and untreated patients, but should be interpreted cautiously because of the observational claims-based design. Findings support optimizing care pathways and expanding access to appropriate treatment to improve outcomes and system efficiency.
METHODS: A retrospective cohort study used secondary administrative claims data from SUS. Patients with stroke (ICD-10 I61, I63, I64) and subsequent PSS-related diagnoses identified from 2016 to 2023 were included if they had at least 12 months of follow-up. Patients were grouped as BT-treated, non-pharmacological treatment, or no treatment. Descriptive analyses assessed treatment patterns, HRU, and direct medical costs from the public payer perspective.
RESULTS: Among 32,984 patients with PSS, only 5.2% received at least one BT injection within 12 months, while 94.8% did not. Non-pharmacological rehabilitation was common among untreated patients (84.2%), indicating reliance on supportive care. BT exposure was limited: 38.8% of treated patients received only one administration during 2016-2023. BT-treated patients had higher total annual costs per patient (BRL 5,470), but lower monthly costs (BRL 265) than untreated patients (BRL 573), suggesting more efficient long-term resource utilization. In the acute phase (urgent medical care), mean hospitalization cost was BRL 1,538 per patient, with regional variation. Monthly costs declined from BRL 638.11 before BT initiation to BRL 152.40 after treatment.
CONCLUSIONS: This real-world study highlights substantial unmet needs and inequities in PSS management in Brazil. Low BT use and limited persistency suggest barriers to access and care delivery. Descriptive differences in HRU and monthly costs were observed between treated and untreated patients, but should be interpreted cautiously because of the observational claims-based design. Findings support optimizing care pathways and expanding access to appropriate treatment to improve outcomes and system efficiency.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD166
Topic
Economic Evaluation, Health Policy & Regulatory, Real World Data & Information Systems
Topic Subcategory
Distributed Data & Research Networks, Health & Insurance Records Systems
Disease
Neurological Disorders