Cost Minimization Analysis of Bont-As in the Treatment of Upper Limb Spasticity and Cervical Dystonia

Luigi Bartolomei; Anna Rita Bentivoglio; Massimo Bizzarini; Patrizia Maria Caglioni; Luana Cerbarano; Marco Frontoni; Giacomo Lus; Giovanni Majorana; Stefania Alessandra Nassetti; Maurizio Osio; Roberto Ravasio; Roberta Ravenni; Antonio Santoro; Nicola Smania; Flavia Torlizzi; Sebastiana Claudia Valvo

doi:10.33393/grhta.2016.404

Authors

Luigi Bartolomei Neuroscience Department, Neurophysiological Unit, San Bortolo Hospital, Vicenza - Italy
Anna Rita Bentivoglio “Parkinson's Disease and Extrapiramidal Disorders Center”, Institute of Neurology, Università Cattolica del Sacro Cuore, Rome - Italy
Massimo Bizzarini U.O. Neurologia Ospedale Civile di Venezia, Venice - Italy
Patrizia Maria Caglioni Medical Service Manager, Ipsen S.p.A., Milanofiori Nord Assago (Milan) - Italy
Luana Cerbarano “Parkinson's Disease and Extrapiramidal Disorders Center”, Institute of Neurology, Università Cattolica del Sacro Cuore, Rome - Italy
Marco Frontoni Multiple Sclerosis Center, Department of Neurology and Psychiatry, Sapienza, University of Rome, Rome - Italy
Giacomo Lus Multiple Sclerosis Center Second Division of Neurology, Department of Clinical and Experimental Medicine and Surgery “F. Magrassi e A. Lanzara”, Second University of Naples, Naples - Italy
Giovanni Majorana Clinical Neurophysiopathology Unit, Department of Neurology G. Martino Hospital, Messina - Italy
Stefania Alessandra Nassetti U.O.C. Neurologia, IRCCS delle Scienze Neurologiche di Bologna Ospedale Bellaria, Bologna - Italy
Maurizio Osio Clinical Neurophysiology Unit, Department of Neurology Luigi Sacco Hospital, Milan - Italy
Roberto Ravasio Health Economist, Health Publishing & Services, Milan - Italy
Roberta Ravenni Dipartimento di Neuroscienze U.O.C. di Neurologia, Servizio di Neurofisiologia Clinica, Azienda ULSS 18, Rovigo - Italy
Antonio Santoro Dipartimento di Scienze Mediche, U.O.C. di Neurologia, Ospedale Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo (Foggia) - Italy
Nicola Smania Neuromotor and Cognitive Rehabilitation Research Centre, Department of Neurological and Movement Sciences, University of Verona Eurorehabilitation Unit, Borgo Roma University Hospital, Verona - Italy
Flavia Torlizzi “Parkinson's Disease and Extrapiramidal Disorders Center”, Institute of Neurology, Università Cattolica del Sacro Cuore, Rome - Italy
Sebastiana Claudia Valvo U.O.C. Medicina Fisica e Riabilitativa, Azienda Ospedaliera per l'Emergenza Cannizzaro, Catania - Italy

DOI:

https://doi.org/10.33393/grhta.2016.404

Keywords:

BoNT-A, Cervical dystonia, Cost-minimization analysis, Upper limb spasticity

Abstract

Objective Botulinum toxin type A (BoNT-A) injections are recommended for the management of upper limb spasticity (ULS) and cervical dystonia (CD). The main aim of this cost minimization analysis (CMA) was to compare the annual cost per patient for three BoNT-As (Botox®, Dysport® and Xeomin®) in the treatment of ULS or CD in Italy. A budget impact analysis (BIA) was also conducted. Methods The CMA was conducted from the perspective of the Italian National Health Service. Only direct medical costs (BoNT-A and standard therapy) were considered. By using a Delphi panel of twelve Italian Experts in the treatment of ULS and CD, data was collected about BoNT-As (dose, number of administrations and acquisition price) and standard therapy (concomitant medications, visits, Day-Hospital, hospitalizations, etc.). Costs were assessed in Euros 2014. The BIA was conducted to evaluate the pharmaceutical expenditure for the three BoNT-As on a five-year time horizon. A sensitivity analysis was conducted. Results The mean annual cost per patient with ULS was €1,840.20 with Dysport®, €2,067.12 with Botox® and €2,171.05 with Xeomin®. The mean annual cost per patient with CD was €1,353.79 with Dysport®, €1,433.12 with Botox® and €1,503.60 with Xeomin®. In the time horizon considered, the substitution process of Botox® and Xeomin® by Dysport® would result in a total saving of €620,000 when treating ULS and a total saving of €481,000 in the case of CD. Sensitivity and probabilistic analyses showed the robustness of results. Conclusions From the Italian National Health Service's perspective, Dysport® appears to be the cost-saving therapeutic option compared with Botox® and Xeomin® in the treatment of ULS or CD.