OBJECTIVES: Stroke is the largest cause of severe disability in adults. Approximately 40% of survivors at 12-months will have upper or lower limb spasticity. Upper limb spasticity is particularly debilitating as patients may experience difficulties in routine daily activities. Basic treatment includes physiotherapy and oral antispastic agents. The objective of the present study was to analyse the costs and outcomes of BTX-A injections as add-on to the basic treatment for flexed wrist/clenched fist spasticity compared to basic treatment. METHODS: Due to absence of empirical data, a Delphi expert panel of Swedish and Finnish neurologists was convened to estimate treatment outcomes and resource utilisation. On average the experts treated 125 patients per year with BTX-A. Unit costs were obtained from official Swedish and Finnish sources. A decision analytic model was used to compare treatments. The model included outcomes, post-stroke mortality and treatment costs. The model used a health care sector perspective and a 12-month horizon. RESULTS: The Finnish experts estimated that 70% reached their treatment goal with BTX-A compared with 34% with basic treatment (66% / 32% when adjusted for mortality). Medication costs were higher with BTX-A (1,791€ vs. 205€). However, rehabilitation costs (neurologist, GP, nurse, physiotherapy) were lower due to improved treatment outcome (13,097€ vs. 15,940€). Hospitalisation costs were equal (3,055€). Total costs with BTX-A were slightly lower. The weekly need for physiotherapy was the major cost driver. Several sensitivity analyses showed robust results. Results from Sweden will be reported in the final presentation. CONCLUSIONS: The analysis showed that a greater proportion of patients whose treatment included BTX-A therapy reached their treatment goals and as a consequence this reduced the total physiotherapy resources required over time. Moreover the analysis showed that BTX-A therapy was slightly cheaper. Consequently neurologists should consider BTX-A as a treatment for post-stroke spastic patients.