Forsmark Annabelle, Rosengren Linda, Ertzgaard Per
PharmaLex, Göteborg, Sweden.
Ipsen, Kista, Sweden.
Health Econ Rev. 2020 Feb 7;10(1):4. doi: 10.1186/s13561-020-0261-7.
The 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.
Botulinum 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.
The 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.
There 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.
瑞典《医疗保健法》规定患者应享有平等的医疗保健服务。本研究探讨这一规定如何转化为成人痉挛的药物治疗，包括注射A型肉毒杆菌毒素（BoNT-A）和鞘内注射巴氯芬（ITB）泵。为了研究治疗差异背后潜在的经济诱因，研究结果还从卫生经济学角度进行了分析。因此，本研究为明智的决策和政策制定提供了详细而全面的概述。
从销售数据中获取肉毒杆菌毒素的使用情况。在五个郡议会中验证了关于BoNT-A平均治疗剂量和用于痉挛适应症的比例的临床实践，同时统计了所有郡议会的ITB泵数量。使用已发表的成本和生活质量数据来估计实现成本平衡或成本效益所需的有效率。
各医疗区域接受BoNT-A治疗的患者比例在5.8%至13.6%之间，全国平均水平为9.2%。每10万居民中报告的ITB泵数量在各医疗区域之间为3.6至14.1，全国平均为6/10万。实现治疗公平性的估计增量成本为，BoNT-A每年1,976,773欧元，ITB泵每年3,326,692欧元。基于预期的成本节约，4%至15%的有效率抵消了BoNT-A的增量成本。假设没有成本节约，成本效益所需的有效率为14%或36%。
瑞典成人痉挛的药物治疗存在显著差异。总体而言，结果表明治疗使用不足，临床实践需要协调统一。此外，实现治疗公平性的增量成本可能会被与痉挛相关的成本节约所抵消。
