Research Article
Volume 8 Issue 2 - 2020
Economic Analysis of Comprehensive Rehabilitation of Children with Spastic Forms of Cerebral Palsy with and without Botulinum Neurotoxin Type A Injections
Zmanovskaia VA1*, Popkov DA2, Uzdina AI1, Ushakova SA3 and Levitina EV3
1Children Psychoneurological Treatment and Rehabilitation Center “Nadezhda”, Tyumen, Russia
2Russian Research Center for Reconstructive Traumatology and Orthopaedics Named After G.A. Ilizarov, Kurgan, Russia
3Tyumen State Medical University of the Ministry of Health of the Russian Federation, Tyumen, Russia
*Corresponding Author: Zmanovskaia VA, Children Psychoneurological Treatment and Rehabilitation Center “Nadezhda”, Tyumen, Russia.
Received: December 11, 2019; Published: January 10, 2020


Objective: Conduct a comparative economic analysis of comprehensive rehabilitation for children with CP aged from 2 to 14 years with and without botulinum neurotoxin type A (BoNT-A) injections.

Materials and Methods: We followed 149 children with spastic forms of CP (GMFCS II-IV) - 78 boys and 71 girls aged from 2 to 14 years. The study group included 108 children getting abobotulinumtoxinA injections (BoNT-A injections) in the comprehensive rehabilitation program and the control group included 41 children with similar comprehensive treatment without BoNT-A injections, which is the current standard of complex therapy. While conducting an economic analysis (budget impact analysis, BIA and cost-effectiveness analysis, СЕА), only direct costs were taken into account: the cost of BoNT-A therapy, rehabilitation and surgeries.

Results: Children with CP in the study group required their first surgical correction by the age 10.5 ± 2.8 years. 5 children (4.6%) required repeated operations. The children in the control group receiving standard therapy (without BoNT-A injections) were first operated on at the age of 6.7 ± 2.1 years. 39 children (95%) required repeated operations in the control group during their 10 to 12 year period of active growth and development. The economic analysis confirmed that including abobotulinumtoxinA as part of the CP treatment regime would provide savings of 24.744 690.2 roubles per 100 children compared to standard therapy without BoNT-A injections over a 12-year follow-up period. Achieving 1% effectiveness in children with CP using BoNT-A would cost 1,854,426 roubles, however achieving similar outcomes in children with CP without BoNT-A would cost 40,702,271.6 roubles. If BoNT-A therapy was included as part of the comprehensive rehabilitation program, the savings could provide medical treatment for an additional 14% children opposed to a more expensive treatment regime without BoNT-A.

Conclusion: The use of abobotulinumtoxinA as part of comprehensive rehabilitation for children with CP is economically justified. Long-term therapy of children with CP using BoNT-A can provide savings of 24 744 690 roubles per 100 patients compared to the standard therapy over a 12-year follow-up period. Using the statistical data issued on January 01, 2018 of the registry of children with CP in the Tyumen region, the budget savings could be 5,938,726 roubles per year.

Keywords: Cerebral Palsy; Spasticity; GMFCS; Botulinum Toxin Type А; AbobotulinumtoxinA (BoNT-A); Multi-Level Injections; Botulinum Therapy; SEMLS-Single-Event Multilevel Surgery


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Citation: Zmanovskaia VA., et al. “Economic Analysis of Comprehensive Rehabilitation of Children with Spastic Forms of Cerebral Palsy with and without Botulinum Neurotoxin Type A Injections”. EC Pharmacology and Toxicology 8.2 (2020): 01-08.

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