OBJECTIVES:

Approximately one-third of patients who experience stroke and 75% with physical disability after severe traumatic brain injury will develop spasticity. Spasticity is a condition in which certain muscles are continuously contracted. AbobotulinumtoxinA (aboBoNT-A; Dysport®) is used in the management of spasticity, aiming to improve function, quality-of-life and to prevent or delay future musculoskeletal complications or bone deformities. The objective of this research was to evaluate the cost-effectiveness of two dosages of aboBoNT-A (500U and 1000U) compared to best supportive care (BSC) in the management of upper limb spasticity in adults (AULS) from the perspective of the UK NHS.

METHODS:

A lifetime Bayesian state-transition model was developed in which patients transition through the four severity levels of the Disability Assessment Scale (DAS). Flat/uninformative prior probabilities of transitions among all health states were assumed. Clinical input parameters and utility values were derived from aboBoNT-A pivotal studies. Resource use estimates were obtained from the previously published literature on spasticity patients. All other parameters and analyses met the criteria of NICE’s reference case. One-way and probabilistic sensitivity analyses along with scenario analyses were conducted to test robustness.

RESULTS:

The base-case analysis demonstrated that, under the assumptions described above, both doses of aboBoNT-A dominate BSC, i.e. are less costly and more effective. Incremental lifetime QALYs (vs BSC), aboBoNT-A 500U: 0.18; aboBoNT-A 1000U: 0.21. Incremental lifetime Costs (vs BSC), AboBoNT-A 500U: £-47,338; aboBoNT-A 1000U: £-42,969. Sensitivity and scenario analyses found that cost-savings were driven by the choice of resource use estimates and QALY gains by the health state transition probabilities.

CONCLUSIONS:

The management of AULS with aboBoNT-A is likely a cost-effective (and potentially cost-saving) option from the UK NHS perspective. This research highlights the potential benefits of aboBoNT-A to AULS patients, payers and, ultimately, to society.