Cost-effectiveness of Intrathecal Baclofen Therapy in severe refractory non-focal disabling spasticity: a Spanish hospital perspective

ABSTRACT

Background: Current knowledge about long-term economic consequences of Intrathecal Baclofen Therapy (ITB Therapy®) is incomplete.

Methods: A markov model was developed to estimate long-term clinical and economic outcomes with ITB Therapy® and conventional medical management of severe refractory non-focal disabling spasticity. Clinical and cost inputs were obtained through a non-interventional, prospective, observational study in a Spanish neurorehabilitation hospital.

Results: ITB Therapy® increased remaining lifetime costs by €35,605 and resulted in a gain of 1.06 quality-adjusted life-years (QALYs), thus showing an incremental cost-effectiveness ratio (ICER) of €33,619/QALY gained. In alternative scenarios, reflecting other clinical settings and management options, considerably lower ICER values were obtained. In particular, opportunities were identified to improve efficiency by setting clinically and economically sound targets for post-operation length of stay.

Conclusion: In the Spanish setting, ITB Therapy® resulted in an ICER close to €30,000/QALY gained; potential ways to reduce costs and further enhance efficiency can be identified.

KEYWORDS:

• Spasticity
• cost-effectiveness
• intrathecal baclofen therapy
• Spain
• neurorehabilitation
• ITB

Acknowledgments

The authors would like to thank M Álvarez, M Álvarez López-Dóriga and B Martí, employed by Medtronic Ibérica, S.A., for their support and assistance, without which the present study could not have been completed.

Financial & competing interests disclosure

The research for this paper was financially supported by Medtronic Inc. T Marqués, J Benito-Penalva and J Vidal, employed at Institut Guttmann, and J Slof, associate professor at Universitat Autònoma de Barcelona, acknowledge research grants from Medtronic. D Serrano, autonomous consultant, was paid an honorarium to participate in the research described in this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.