Hull Michael, Anupindi Vamshi Ruthwik, He Jing, DeKoven Mitchell, Goldberg Jumaah, Bouchard Jonathan
IQVIA, Falls Church, VA, USA.
Ipsen, 1 Main Street, Suite 700, Cambridge, MA, 02142, USA.
Neurol Ther. 2025 Feb;14(1):261-278. doi: 10.1007/s40120-024-00692-9. Epub 2024 Dec 17.
Post-stroke spasticity (PSS) occurs in ~25-43% of patients between 2 weeks and 3 months following a stroke. This retrospective claims study examined the occurrence of spasticity, treatment patterns, healthcare resource utilization, and healthcare costs among patients who experienced a stroke over a 2-year period.
Analyses were conducted using healthcare claims from the IQVIA PharMetrics Plus database of commercially/self-insured members from 2015 to 2021. Patients were selected based on two International Classification of Diseases, 10th revision diagnosis codes for stroke requiring an inpatient stay (index date) with continuous enrollment with medical/pharmacy benefits 12 months before (pre-index) and 24 months starting on the index date (post-index). PSS was defined by a diagnosis code for spastic hemiplegia or muscle contracture starting ≥ 7 days post-index, or claims indicating PSS treatment [botulinum toxin A (BoNT-A) or muscle relaxants] any time in the post-index period. A generalized linear model was developed to estimate cost ratios between patients with and without PSS.
Overall, 7851 patients fulfilled study criteria; 47.7% were treated with physical or occupational therapy, 11.3% with muscle relaxants, and 0.8% with BoNT-A; 12.4% met the post-index definition of PSS; 84.2% were identified using muscle relaxant or BoNT-A codes, 6.6% using diagnosis codes, and 9.2% using both. Median time to codes identifying PSS was 213 days. Patients treated with BoNT-A received an average of three treatments, starting 253 days (median) post-stroke. Mean all-cause healthcare costs were US$62,875 among patients with PSS versus $44,472 among patients without (P < 0.001), representing 39.6% higher adjusted all-cause healthcare costs among patients with PSS versus patients without PSS.
Patients with PSS utilized numerous treatment modalities and experienced higher mean all-cause healthcare costs than did those without PSS. Earlier identification to optimize treatment of PSS may represent an opportunity for cost savings within managed healthcare systems.
中风后痉挛（PSS）发生在中风后2周3个月内的患者中，发生率约为25%43%。这项回顾性索赔研究调查了2年内中风患者的痉挛发生情况、治疗模式、医疗资源利用情况和医疗费用。
使用IQVIA PharMetrics Plus数据库中2015年至2021年商业/自保成员的医疗索赔进行分析。根据第十版国际疾病分类的两个中风诊断代码选择患者，这些患者需要住院治疗（索引日期），并在索引日期前12个月（索引前）和索引日期开始后的24个月（索引后）持续享有医疗/药房福利。PSS的定义为索引日期后≥7天开始的痉挛性偏瘫或肌肉挛缩诊断代码，或索引后期间任何时间表明PSS治疗的索赔（肉毒杆菌毒素A（BoNT-A）或肌肉松弛剂）。建立了一个广义线性模型来估计有和没有PSS的患者之间的成本比率。
总体而言，7851名患者符合研究标准；47.7%接受了物理或职业治疗，11.3%接受了肌肉松弛剂治疗，0.8%接受了BoNT-A治疗；12.4%符合索引后PSS的定义；84.2%通过肌肉松弛剂或BoNT-A代码识别，6.6%通过诊断代码识别，9.2%两者都使用。识别PSS的代码的中位时间为213天。接受BoNT-A治疗的患者平均接受三次治疗，中风后253天（中位数）开始。PSS患者的全因平均医疗费用为62,875美元，无PSS患者为44,472美元（P<0.001），这表明PSS患者的调整后全因医疗费用比无PSS患者高39.6%。
PSS患者使用了多种治疗方式，并且与无PSS的患者相比，全因平均医疗费用更高。早期识别以优化PSS治疗可能是管理式医疗系统中节省成本的一个机会。
