OBJECTIVES

: Stroke is associated with high risk of mortality and recurrent cardiovascular events, with risk increasing for people with comorbidities. Rehabilitation is critical for improving functional recovery, and was shown to reduce hospital readmissions, as well as all-cause and cardiovascular mortality and stroke recurrence (long-term outcomes), but spasticity (occurring in 30% of stroke survivors) may prevent effective recovery. AbobotulinumtoxinA (ABoNTA) is an established treatment for post-stroke spasticity (PSS), but its impact on long-term outcomes is unknown. The goal was to model the clinical and economic effects of ABoNTA treatment on long-term outcomes in PSS.

METHODS

: Effects of ABoNTA on functional outcomes such as the Functional Independence Measure (FIM), and the impact of functional outcomes on long-term outcomes, were estimated from literature review and meta-analyses. A model was developed based on associations between ABoNTA, functional, and long-term outcomes. Cost-effectiveness analysis compared rehabilitation therapy (RT) with ABoNTA versus RT alone from the UK NHS perspective. Resource use and utilities were retrieved from the literature and modelled over a 10-year time horizon.

RESULTS

: Using the FIM, the model found a risk reduction of 8.8% for all-cause mortality for RT + ABoNTA versus RT alone. In the base case, RT + ABoNTA led to an increase of 13% in life-years and 59% in quality-adjusted life years [QALYs] (1.7 gained). RT + ABoNTA was considered cost-effective versus RT alone (incremental cost-effectiveness ratio [ICER]: £24,602). Sensitivity analysis showed that healthcare resources, quality-of-life, relative risks for all-cause mortality and effect of interventions had the most influence on the ICER. The ICER remained below the £30,000 threshold in a sensitivity analysis on the source of overall survival data (range: £24,602-£28,983).

CONCLUSIONS

: In addition to being a cost-effective use of resources, treatment of PSS with ABoNTA and RT may lead to improved survival with considerable clinical and economic benefits.