Anthony Ward ^A1, Graeme Roberts ^A2, Juliet Warner ^A3, Samantha Gillard ^A3
A1 North Staffordshire Rehabilitation Unit, The Hayward, Stoke-on-Trent, Staffordshire
^A2 Allergan Ltd, Buckinghamshire
^A3 Abacus International, Bicester, Oxfordshire, UK
DOI: 10.1080/16501970510027312

Objective: Treatment strategies for post-stroke spasticity include oral anti-spastic drugs, surgery, physiotherapy and botulinum toxin type A injection. The objective of this study was to compare the cost-effectiveness and outcomes of oral therapy vs. botulinum toxin type A treatment strategies in patients with flexed wrist/clenched fist spasticity. Methods: Treatment outcome and resource use data were collected from an expert panel experienced in the treatment of post-stroke spasticity. A decision tree model was developed to analyse the data. Results: Thirty-five percent of patients receiving oral therapy showed an improvement in pre-treatment functional targets which would warrant continuation of therapy, compared with 73% and 68% of patients treated with botulinum toxin type A first- and second-line therapy, respectively. Botulinum toxin type A treatment was also more cost-effective than oral therapy with the “cost-per-successfully-treated month” being £942, £1387 and £1697 for botulinum toxin type A first-line, botulinum toxin type A second-line and oral therapy, respectively. Conclusion: In conclusion, botulinum toxin type A is a cost-effective treatment for post-stroke spasticity.