Economic Evaluation of the InTENSE Program of Therapy Alongside Botulinum Neurotoxin a for the Rehabilitation of Chronic Upper Limb Spasticity
Spasticity is a persistent and debilitating consequence of stroke and effective rehabilitation is a healthcare priority. Botulinum neurotoxin A (BoNT-A) with supportive therapy has increasingly been embedded within clinical practice for treatment of post-stroke spasticity. But the evidence for this...
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MDPI AG
2025-07-01
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| author | Rachel Milte Jia Song Sean Docking Julie Ratcliffe Ian D. Cameron Maria Crotty Louise Ada Coralie English Natasha A. Lannin |
| author_facet | Rachel Milte Jia Song Sean Docking Julie Ratcliffe Ian D. Cameron Maria Crotty Louise Ada Coralie English Natasha A. Lannin |
| author_sort | Rachel Milte |
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| description | Spasticity is a persistent and debilitating consequence of stroke and effective rehabilitation is a healthcare priority. Botulinum neurotoxin A (BoNT-A) with supportive therapy has increasingly been embedded within clinical practice for treatment of post-stroke spasticity. But the evidence for this approach has hitherto been limited to the findings of a limited number of small trials. The InTENSE trial was undertaken specifically to provide high-quality clinical trial evidence focusing on the effect of BoNT-A and adjunctive therapy on upper limb spasticity. While the clinical trial did not detect a significant impact upon clinical outcomes, there remains a need to evaluate any impact on the broader use of healthcare resources and overall cost-effectiveness. A detailed cost–utility analysis of the InTENSE trial was undertaken. The costs over the 12-month follow-up period were compared with quality-adjusted life years (QALY) gained using utilities generated from the EQ-5D three level (EQ-5D-3L) instrument. There were no significant differences in QALY gained between the intervention and control groups identified, or in the majority of health and community care costs. The Incremental Cost-Effectiveness Ratio per QALY gained was estimated at AU $63,947.11 (Australian dollars), which is well above accepted thresholds for cost-effectiveness in Australia. The study was unable to identify evidence for the cost-effectiveness of treatment approaches combining BoNT-A with adjunctive therapy. |
| format | Article |
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| institution | DOAJ |
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| language | English |
| publishDate | 2025-07-01 |
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| spelling | doaj-art-e3e2f9b68b5d42ea94c52ac7817e753a2025-08-20T03:08:05ZengMDPI AGToxins2072-66512025-07-0117734110.3390/toxins17070341Economic Evaluation of the InTENSE Program of Therapy Alongside Botulinum Neurotoxin a for the Rehabilitation of Chronic Upper Limb SpasticityRachel Milte0Jia Song1Sean Docking2Julie Ratcliffe3Ian D. Cameron4Maria Crotty5Louise Ada6Coralie English7Natasha A. Lannin8Caring Futures Institute, Flinders University, Adelaide, SA 5001, AustraliaCaring Futures Institute, Flinders University, Adelaide, SA 5001, AustraliaSchool of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, AustraliaCaring Futures Institute, Flinders University, Adelaide, SA 5001, AustraliaSydney School of Health Sciences, University of Sydney, Sydney, NSW 2006, AustraliaCollege of Medicine and Public Health, Flinders University, Adelaide, SA 5001, AustraliaSydney School of Health Sciences, University of Sydney, Sydney, NSW 2006, AustraliaSchool of Health Sciences, University of Newcastle, Callaghan, NSW 2308, AustraliaDepartment of Neuroscience, Monash University, Alfred Health, Melbourne, VIC 304, AustraliaSpasticity is a persistent and debilitating consequence of stroke and effective rehabilitation is a healthcare priority. Botulinum neurotoxin A (BoNT-A) with supportive therapy has increasingly been embedded within clinical practice for treatment of post-stroke spasticity. But the evidence for this approach has hitherto been limited to the findings of a limited number of small trials. The InTENSE trial was undertaken specifically to provide high-quality clinical trial evidence focusing on the effect of BoNT-A and adjunctive therapy on upper limb spasticity. While the clinical trial did not detect a significant impact upon clinical outcomes, there remains a need to evaluate any impact on the broader use of healthcare resources and overall cost-effectiveness. A detailed cost–utility analysis of the InTENSE trial was undertaken. The costs over the 12-month follow-up period were compared with quality-adjusted life years (QALY) gained using utilities generated from the EQ-5D three level (EQ-5D-3L) instrument. There were no significant differences in QALY gained between the intervention and control groups identified, or in the majority of health and community care costs. The Incremental Cost-Effectiveness Ratio per QALY gained was estimated at AU $63,947.11 (Australian dollars), which is well above accepted thresholds for cost-effectiveness in Australia. The study was unable to identify evidence for the cost-effectiveness of treatment approaches combining BoNT-A with adjunctive therapy.https://www.mdpi.com/2072-6651/17/7/341strokerehabilitationbotulinum neurotoxin Aeconomic evaluationcost–utility analysiscost-effectiveness analysis |
| spellingShingle | Rachel Milte Jia Song Sean Docking Julie Ratcliffe Ian D. Cameron Maria Crotty Louise Ada Coralie English Natasha A. Lannin Economic Evaluation of the InTENSE Program of Therapy Alongside Botulinum Neurotoxin a for the Rehabilitation of Chronic Upper Limb Spasticity Toxins stroke rehabilitation botulinum neurotoxin A economic evaluation cost–utility analysis cost-effectiveness analysis |
| title | Economic Evaluation of the InTENSE Program of Therapy Alongside Botulinum Neurotoxin a for the Rehabilitation of Chronic Upper Limb Spasticity |
| title_full | Economic Evaluation of the InTENSE Program of Therapy Alongside Botulinum Neurotoxin a for the Rehabilitation of Chronic Upper Limb Spasticity |
| title_fullStr | Economic Evaluation of the InTENSE Program of Therapy Alongside Botulinum Neurotoxin a for the Rehabilitation of Chronic Upper Limb Spasticity |
| title_full_unstemmed | Economic Evaluation of the InTENSE Program of Therapy Alongside Botulinum Neurotoxin a for the Rehabilitation of Chronic Upper Limb Spasticity |
| title_short | Economic Evaluation of the InTENSE Program of Therapy Alongside Botulinum Neurotoxin a for the Rehabilitation of Chronic Upper Limb Spasticity |
| title_sort | economic evaluation of the intense program of therapy alongside botulinum neurotoxin a for the rehabilitation of chronic upper limb spasticity |
| topic | stroke rehabilitation botulinum neurotoxin A economic evaluation cost–utility analysis cost-effectiveness analysis |
| url | https://www.mdpi.com/2072-6651/17/7/341 |
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