Table 3.
Required proportion of BoNT-A treatment responders for cost balance at different degrees of association between spasticity and cost
| Scenario | Difference in annual cost between severe and moderate spasticity (EUR) | Required responder rate* for cost balance |
|---|---|---|
| Base case scenarioa | ~ 45,000 | 4% |
| Excl. indirect costs | ~ 39,000 | 4% |
| Association between spasticity and costsb | ||
| - 75% | 33,750 | 5% |
| - 50% | 22,500 | 8% |
| - 25% | 11,250 | 15% |
| Required responder rate* for cost effectiveness# | ||
| QALY weights according to Doan et al. [11] | 36% | |
| QALY weights according to Svensson et al. [5] | 14% | |
aBase case scenario; 34% of hospital BoNT-A use for spasticity, cost per BoNT-A treatment session = 574 EUR, full causal (100%) relationship between change of spasticity severity grade and associated cost (45,000 EUR)
bEffects of decreased influence on the costs (45,000 EUR, see Method section) associated with transition between severity grades of spasticity
*In accordance with the study by Doan et al., treatment responders were defined as patients transitioning to a lower level of disability (severe to moderate), as defined by the Disability Assessment Scale (DAS) [11]
#based on a Willingness To Pay of ~ 52,000 EUR (corresponding to 500,000 SEK at the mean exchange rate for 2017; 1 SEK = 9.6 EUR), and assuming transition of responders at first injection and subsequent stability for at least a year