Sanz-Granda A, Marti M J, Catalan M J
Proyectos de Farmacoeconomia, Las Rozas, Espana.
Hospital Clinic de Barcelona, 08036 Barcelona, Espana.
Rev Neurol. 2018 Dec 16;67(12):465-472.
Studies on focal dystonia showed that the formulations of botulinum toxin type A, incobotulinumtoxin-A (Inco-BTA) and onabotulinumtoxin-A (Ona-BTA), have equivalent efficacy and safety.
To carry-out a cost-utility analysis of Inco-BTA administered on flexible intervals vs. Ona-BTA on a fixed interval, in the treatment of blepharospasm and cervical dystonia.
A probabilistic Markov model was designed to estimate costs (euros, 2017) and benefits (quality-adjusted life years, QALY), from the Spanish National Health Service perspective and on a 5-year time horizon, of treatment of blepharospasm and cervical dystonia with Inco-BTA (6-12 month flexible intervals) versus Ona-BTA (12-month fixed intervals). It is assumed that symptoms will re-emerge some time later in both options. Result was expressed as incremental cost-utility ratio (ICUR).
Inco-BTA and Ona-BTA costs were 3,742 and 3,366 euros respectively, in blepharospasm, and 6,673 and 6,419 euros in cervical dystonia. Patients treated with Inco-BTA remained asymptomatic for 22.12, and 21.34 more weeks than those treated with Ona-BTA, leading in 3.040 and 3.012 QALY, respectively, in blepharospasm, and 3.471 and 3.401 QALY, respectively, in cervical dystonia. Differences showed statistical significance in all cases. ICUR was estimated as 13,576 and 4,158 euros/QALY in blepharospasm and cervical dystonia, respectively.
Treatment of blepharospasm and cervical dystonia with Inco-BTA is a cost-effective therapeutic alternative in Spain, based on the flexibility of their administration.
局灶性肌张力障碍的研究表明，A型肉毒毒素制剂，即incobotulinumtoxin-A（Inco-BTA）和onabotulinumtoxin-A（Ona-BTA），具有等效的疗效和安全性。
对Inco-BTA灵活间隔给药与Ona-BTA固定间隔给药治疗眼睑痉挛和颈部肌张力障碍进行成本效益分析。
设计了一个概率马尔可夫模型，从西班牙国家卫生服务的角度，在5年的时间范围内，估计用Inco-BTA（6 - 12个月灵活间隔）与Ona-BTA（12个月固定间隔）治疗眼睑痉挛和颈部肌张力障碍的成本（欧元，2017年）和效益（质量调整生命年，QALY）。假设两种方案中症状稍后都会再次出现。结果以增量成本效益比（ICUR）表示。
在眼睑痉挛中，Inco-BTA和Ona-BTA的成本分别为3742欧元和3366欧元，在颈部肌张力障碍中分别为6673欧元和6419欧元。接受Inco-BTA治疗的患者比接受Ona-BTA治疗的患者无症状时间分别多22.12周和21.34周，在眼睑痉挛中分别导致3.040和3.012个QALY，在颈部肌张力障碍中分别为3.471和3.401个QALY。所有情况下差异均具有统计学意义。在眼睑痉挛和颈部肌张力障碍中，ICUR估计分别为13576欧元/QALY和4158欧元/QALY。
基于给药的灵活性，在西班牙，用Inco-BTA治疗眼睑痉挛和颈部肌张力障碍是一种具有成本效益的治疗选择。
