Estimating the cost consequence of the early use of botulinum toxin in post-stroke spasticity: Secondary analysis of a randomised controlled trial

Cameron Lindsay, Ioan Humphreys, Ceri Phillips, Anand Pandyan, Cameron Lindsay, Ioan Humphreys, Ceri Phillips, Anand Pandyan

Abstract

Objective: To estimate the cost-consequence of treating spasticity early with botulinum toxin in the acute stroke unit.

Design: Secondary cost-consequence analysis, using data from a double-blind randomised-controlled trial.

Setting: Single-centre specialised stroke unit.

Subjects and interventions: Patients with Action Research Arm Test grasp-score of <2 and who developed spasticity within six weeks of a first stroke were randomised to receive injections of: 0.9% sodium-chloride solution (placebo) or onabotulinumtoxin-A (treatment).

Main measures: Resource use costs were calculated for the study. Mean contracture costs for each group were calculated. The Barthel Index and Action Research Arm Test were used to generate a cost per unit of improvement.

Results: There were no significant differences associated with early treatment use. The mean contracture cost for the treatment group was £817 and for the control group was £2298 (mean difference = -£1481.1(95% CI -£2893.5, -£68.7) (p = 0.04). The cost per unit of improvement for the Barthel Index was -£1240 indicating that the intervention costs less and is more effective. The cost per unit of improvement for the Action Research Arm Test was -£450 indicating that the intervention costs less and is more effective.

Conclusions: Treating spasticity early in stroke patients at risk of contractures with botulinum toxin leads to a significant reduction in contracture costs. The cost per improvement of Barthel and Action Research Arm Test indicates that the intervention costs less and is more effective.

Trial registration data: EudraCT(2010-021257-39) and ClinicalTrials.gov-Identifier:NCT01882556.

Keywords: Stroke; botulinum toxin; economic evaluation; spasticity.

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Consort flow chart summarising the flow of participants through the study. The last value was carried forward in cases of missing values. SAH: subarachnoid haemorrhage; SOL: space occupying lesion.

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