Abstract
BackgroundThe Swedish Healthcare Act states that patients should have equal access to healthcare. This study addresses at how this translates to pharmacological treatment of adult spasticity, including injections with botulinum toxin A (BoNT-A) and pumps for intrathecal baclofen (ITB). To address potential economic incentives for treatment differences, the results are also set into a health economic perspective.Thus, the current study provides a detailed and comprehensive overview for informed decision- and policymaking.MethodsBotulinum toxin use was retrieved from sales data. Clinical practice regarding mean BoNT-A treatment dose and proportion used for spasticity indication were validated in five county councils, while the number of ITB pumps were mapped for all county councils. Published costs and quality of life data was used for estimating required responder rates for cost-balance or cost-effectiveness.ResultsThe proportion of patients treated with BoNT-A varied between 5.8% and 13.6% across healthcare regions, with a mean of 9.2% on a national level. The reported number of ITB pumps per 100,000 inhabitants varied between 3.6 and 14.1 across healthcare regions, with a national mean of 6/100,000.The estimated incremental cost for reaching treatment equity was EUR 1,976,773 per year for BoNT-A and EUR 3,326,692 for ITB pumps. Based on expected cost-savings, responder rates ranging between 4% and 15% cancelled out the incremental cost for BoNT-A. Assuming no cost-savings, responder rates of 14% or 36% was required for cost-effectiveness.ConclusionsThere is a marked variation in pharmacologic treatment of adult spasticity in Sweden. Overall, the results indicate an underuse of treatment and need for harmonisation of clinical practice. Furthermore, the incremental cost for reaching treatment equity is likely to be offset by spasticity-associated cost-savings.
Highlights
Spasticity is a common complication of injuries to the central nervous system that often has a negative impact on functioning and can cause severe disability [1]
Analyses For this analysis, the proportion of hospital botulinum toxin A (BoNT-A) use was validated in those county councils where the reporting centers manage most of the region’s spasticity treatment
The incremental cost of filling the estimated treatment gap was assessed by assuming that the county council with the highest level of BoNT-A use is closest to an optimal treatment level
Summary
Spasticity is a common complication of injuries to the central nervous system that often has a negative impact on functioning and can cause severe disability [1]. Injections with botulinum toxin type A (BoNT-A) is the Sweden lacks national treatment guidelines regarding management of spasticity, leaving room for local variations in clinical practice. This has been reported in a (2020) 10:4 previous publication, where a marked variation in BoNT-A treatment of adult spasticity was observed [6]. The aim of the current study was to substantiate if the observed differences are persistent and extend to other pharmacological treatment of spasticity. This study addresses at how this translates to pharmacological treatment of adult spasticity, including injections with botulinum toxin A (BoNT-A) and pumps for intrathecal baclofen (ITB). The current study provides a detailed and comprehensive overview for informed decision- and policymaking
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