Hadnorntun Phorntida, Prawjaeng Juthamas, Kongmalai Tanawan, Tanvijit Phakamas, Chueluecha Chuenchom, Jintakul Nawarat, Saringcarinkul Tipyarat, Srinonprasert Varalak, Kumthornthip Witsanu, Leelahavarong Pattara
Siriraj Health Policy Unit, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
Division of Endocrinology and Metabolism, Department of Medicine, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, Thailand.
BMJ Open. 2025 Jan 6;15(1):e090701. doi: 10.1136/bmjopen-2024-090701.
To evaluate the cost-utility of botulinum toxin A (BoNT-A) for treating upper limb (UL) and lower limb (LL) post-stroke spasticity.
Using a Markov model, adopting a societal perspective and a lifetime horizon with a 3% annual discount rate, the cost-utility analysis was conducted to compare BoNT-A combined with standard of care (SoC) with SoC alone. Costs, utilities, transitional probabilities and treatment efficacy were derived from 5-year retrospective data from tertiary hospitals and meta-analysis. Uncertainty analyses were performed.
Tertiary hospitals in Thailand.
Cohort of post-stroke patients aged 55 years with UL or LL spasticity and a Modified Ashworth Scale score ≥1+.
BoNT-A (abobotulinumtoxinA: aboBoNT-A, onabotulinumtoxinA: onaBoNT-A or prabotulinumtoxinA: praBoNT-A) combined with SoC versus SoC alone.
Expected life years, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratios (ICERs), considering a cost-effectiveness threshold of 160 000 THB (US$4468) per QALY gained.
The combination of aboBoNT-A and SoC yielded the highest QALYs gained (0.013 for UL and 0.11 for LL), followed by onaBoNT-A and SoC and praBoNT-A and SoC. The additional costs for treating UL and LL cases were highest for onaBoNT-A US$75 and US$95, respectively, followed by aboBoNT-A and praBoNT-A. ICER values for treating UL with aboBoNT-A, onaBoNT-A and praBoNT-A ranged from US$4669 to US$7541 per QALY. For LL treatments, aboBoNT-A and onaBoNT-A had ICER values ranging from US$7072 to US$15 182 per QALY. Integrating BoNT-A treatment delivery into the healthcare system would require a budget outlay of approximately US$413 246-US$966 103 that may vary annually by an additional US$50 260-US$335 064.
BoNT-A effectively reduces focal spasticity and improves quality of life in post-stroke patients. However, its cost-effectiveness in Thailand necessitates price negotiations as a condition for inclusion in the pharmaceutical reimbursement list.
评估A型肉毒毒素（BoNT-A）治疗中风后上肢（UL）和下肢（LL）痉挛的成本效益。
采用马尔可夫模型，从社会角度出发，以3%的年贴现率进行终身评估，进行成本效益分析，比较BoNT-A联合标准治疗（SoC）与单纯SoC。成本、效用、转移概率和治疗效果来自三级医院的5年回顾性数据和荟萃分析。进行了不确定性分析。
泰国的三级医院。
年龄≥55岁、患有UL或LL痉挛且改良Ashworth量表评分≥1+的中风后患者队列。
BoNT-A（阿泊肉毒毒素A：aboBoNT-A、昂丹司琼肉毒毒素A：onaBoNT-A或普拉肉毒毒素A：praBoNT-A）联合SoC与单纯SoC。
预期寿命年数、质量调整生命年（QALY）、成本和增量成本效益比（ICER），考虑到每获得1个QALY的成本效益阈值为160 000泰铢（4468美元）。
aboBoNT-A与SoC联合使用获得的QALY最高（UL为0.013，LL为0.11），其次是onaBoNT-A与SoC以及praBoNT-A与SoC。治疗UL和LL病例的额外成本，onaBoNT-A分别最高，为75美元和95美元，其次是aboBoNT-A和praBoNT-A。用aboBoNT-A、onaBoNT-A和praBoNT-A治疗UL的ICER值为每QALY 4669美元至7541美元。对于LL治疗，aboBoNT-A和onaBoNT-A的ICER值为每QALY 7072美元至15 182美元。将BoNT-A治疗纳入医疗保健系统需要约413 246美元至966 103美元的预算支出，每年可能会额外增加50 260美元至335 064美元。
BoNT-A可有效减轻中风后患者的局灶性痉挛并改善生活质量。然而，其在泰国的成本效益需要进行价格谈判，作为列入药品报销清单的条件。
