Continuous intrathecal baclofen infusion for intractable spastic cerebral palsy--is it worth it?

This Practice Point commentary discusses a recent paper by Hoving et al., who compared the cost-effectiveness of continuous intrathecal baclofen infusion (CIBI) with that of 'standard care' in children with cerebral palsy whose abnormal muscle tone was interfering with function and/or quality of life. The current management of severe spasticity and dystonia in cerebral palsy consists of oral medications, botulinum toxin, selective dorsal rhizotomy, orthopedic surgery, and/or CIBI. CIBI is the treatment of choice for patients whose severely abnormal tone is interfering with their care, comfort, and/or quality of life. The added cost of care associated with the use of CIBI for 1 year is nearly twice that of standard care. However, on the basis of their cost-effectiveness analysis, which took into consideration the improvement in quality of life, Hoving et al. concluded that the added expense is cost-effective. Although this prospective study lasted for only 1 year and included only 15 patients, the conclusions are similar to those based on previously published results.