Cost-effectiveness Modeling of Intrathecal Baclofen Therapy Versus Other Interventions for Disabling Spasticity

被引:43
作者
Bensmail, D. [2 ]
Ward, A. B. [3 ]
Wissel, J. [4 ]
Motta, F. [5 ]
Saltuari, Leopold [6 ]
Lissens, J. [7 ]
Cros, S. [7 ]
Beresniak, A. [1 ,8 ]
机构
[1] Data Min Int, CH-1215 Geneva 15, Switzerland
[2] Versailles St Quentin Univ, AP HP, Grp Hosp R Poincare,Hop Maritime Berck, Dept Phys Med & Rehabil, Garches, France
[3] N Staffordshire Rehabil Ctr, Stoke On Trent, Staffs, England
[4] Neurol Rehabil Hosp, Beelitz, Germany
[5] V Buzzi Childrens Hosp, Dept Paediat Orthopaed, Milan, Italy
[6] Oesterreich Landeskrankenhaus Hochzirl, Neurol Akutnachsorge Abt, Hochzirl, Austria
[7] Metron Int, Tolochenaz, Switzerland
[8] Paris Descartes Univ, LIRAES, Paris, France
关键词
Cerebral palsy; Multiple sclerosis; Spinal cord injury; Rehabilitation; Spasticity; Baclofen; Models (economic); CEREBRAL-PALSY; MULTIPLE-SCLEROSIS; CHILDREN; ORIGIN;
D O I
10.1177/1545968308328724
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective. To assess by simulation the cost-effectiveness of intrathecal baclofen (ITB) therapy compared with conventional medical treatments for patients with disabling spasticity and functional dependence caused by any neurological disease. Methods. Two models were created to simulate therapeutic strategies for managing severe spasticity, one with and one without the use of ITB, to assess various treatment sequences over 2 years based on current medical practices in France. Successful treatment at each evaluation was defined as a combination of: (1) the increased patient and caregiver satisfaction as assessed by goal attainment scaling (GAS), and (2) a decrease of at least 1 point on the Ashworth score. Probabilistic sensitivity analyses were performed using 5000 Monte-Carlo simulations taking into account specific distribution curves for direct costs and effectiveness parameters in each treatment option. Results. The model simulations suggest that including ITB as a first option strategy in the management of function of severely impaired patients with disabling spasticity results in a higher success rate (78.7% vs 59.3%; P < .001). In addition, the ITB therapy model revealed a lower cost ((sic)59 391 vs (sic)88 272; P < .001) and an overall more favorable cost-effectiveness ratio ((sic)75 204/success vs (sic)148 822/success; P < .001), compared with conventional medical management without ITB. Conclusion. Within the assumptions of our modeling, ITB therapy evaluated by a combination of treatment success criteria at 6-month intervals over a 2-year period may be a cost-effective strategy compared to conventional medical management alone.
引用
收藏
页码:546 / 552
页数:7
相关论文
共 22 条
[1]   Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin [J].
Albright, AL ;
Gilmartin, R ;
Swift, D ;
Krach, LE ;
Ivanhoe, CB ;
McLaughlin, JF .
JOURNAL OF NEUROSURGERY, 2003, 98 (02) :291-295
[2]   Goal attainment for spasticity management using botulinum toxin [J].
Ashford, Stephen ;
Turner-Stokes, Lynne .
PHYSIOTHERAPY RESEARCH INTERNATIONAL, 2006, 11 (01) :24-34
[3]   Intrathecal baclofen for treatment of spasticity of multiple sclerosis patients [J].
Ben Smail, D ;
Peskine, A ;
Roche, N ;
Mailhan, L ;
Thiébaut, JB ;
Bussel, B .
MULTIPLE SCLEROSIS, 2006, 12 (01) :101-103
[4]  
BLICHER JU, 2008, NEUROREHABIL NEURAL
[5]   Outcome measurement of effectiveness of botulinum toxin type A in children with cerebral palsy: an ICIDH-2 approach [J].
Boyd, RN ;
Hays, RM .
EUROPEAN JOURNAL OF NEUROLOGY, 2001, 8 :167-177
[6]   Cost-effectiveness of intrathecal baclofen therapy for the treatment of severe spasticity associated with cerebral palsy [J].
de Lissovoy, Gregory ;
Matza, Louis S. ;
Green, Hannah ;
Werner, Meghan ;
Edgar, Terence .
JOURNAL OF CHILD NEUROLOGY, 2007, 22 (01) :49-59
[7]   Limitations of the methods used for calculating quality-adjusted life-year values [J].
Duru, G ;
Auray, JP ;
Béresniak, A ;
Lamure, M ;
Paine, A ;
Nicoloyannis, N .
PHARMACOECONOMICS, 2002, 20 (07) :463-473
[8]   Intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a cost-effectiveness analysis [J].
Hoving, M. A. ;
Evers, S. M. A. A. ;
Ament, A. J. H. A. ;
van Raak, E. P. M. ;
Vles, J. S. H. .
DEVELOPMENTAL MEDICINE AND CHILD NEUROLOGY, 2008, 50 (06) :450-455
[9]   Modeling the simple epidemic with deterministic differential equations and random initial conditions [J].
Kegan, B ;
West, RW .
MATHEMATICAL BIOSCIENCES, 2005, 195 (02) :179-193
[10]   Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis [J].
Khan, Fary ;
Pallant, Julie F. ;
Turner-Stokes, Lynn .
ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION, 2008, 89 (04) :652-659