OBJECTIVES: AbobotulinumtoxinA (aboBoNT-A), an injectable form of botulinum toxin type A, is approved for use in adults with upper limb spasticity (ULS). A cost-effectiveness model was developed to estimate the costs and health outcomes associated with treatment with aboBoNT-A in Sweden compared to best supportive care (BSC) only in patients with ULS.

METHODS: A health state transition model assessed accumulated life-time costs, life years and quality adjusted life years (QALY). Health states were based on disease severity, defined according to the Disability Assessment Scale (DAS). Transition probabilities between health states were derived from changes in DAS scores observed in pivotal randomized and open-label extension clinical studies of aboBoNT-A during the first year, and extrapolated over the remaining time horizon.

Costs included country-specific data on intervention cost, other health care costs as well as informal care costs. Data on utility was based both on SF-36 data from the pivotal clinical study, mapped to utilities, and from literature sources. The base case analysis applied a conservative approach assuming no difference in health care costs, other than for drug acquisition and injections.

RESULTS: AboBoNT-A-treated patients were associated with ~78,000 SEK higher costs and accrued 0.44 more QALYs per patient, compared to BSC. Hence, treatment of ULS with aboBoNT-A resulted in a base case incremental cost per QALY gained of about 177,000 SEK (~18,600 EUR). The result was sensitive to utility weights, discontinuation rates and initial health state distribution.

CONCLUSIONS: Results indicates that, based on existing evidence and country-specific treatment costs, the management of ULS in Sweden with aboBoNT-A is likely to be a cost-effective treatment option compared to BSC, with a cost per QALY gained within an acceptable limit. More data on real-life use of aboBoNT-A and its long-term impact on utility and health care costs would increase the certainty of these findings.