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




Abstract

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

References

  1. Zmanovskaya VA., et al. “Long-term use of botulinum toxin type A: Dysport® in the comprehensive rehabilitation of children with spastic forms of cerebral palsy”. Journal of Neurology, Neurosurgery, and Psychiatry 7 (2014): 33-36.
  2. Kolbin AS., et al. “Pharmacoeconomics of the use of botulinum toxin preparations in comprehensive treatment of cerebral palsy”.
  3. Kulikov A., et al. “Pharmacoeconomic analysis of different types of treatment for spastic forms of cerebral palsy”. Pharmacoeconomics: Theory and Practice 3.3 (2015).
  4. Popkov DA., et al. “The results of single-event multilevel orthopedic operations and early rehabilitation in combination with botulinum therapy in patients with spastic forms of cerebral palsy”. Journal of Neurology, Neurosurgery, and Psychiatry 115.4 (2015): 41-48.
  5. Abel M., et al. “Muscle-tendon surgery in diplegic cerebral palsy: functional and mechanical changes”. Journal of Pediatric Orthopaedics 19 (1999): 366-375.
  6. Aiona MD and Sussman MD. “Treatment of spastic diplegia in patients with cerebral palsy: part II”. Journal of Pediatric Orthopaedics 13 (2004): S1-S38.
  7. Brin MF and Blitzer A. “Botulinum toxin: dangerous terminology errors”. Journal of the Royal Society of Medicine 86.8 (1993): 493-504.
  8. CDC, Data and statistics for cerebral palsy (2016). 
  9. Damiano DL., et al. “New Clinical and Research Trends in Lower Extremity Management for Ambulatory Children with cerebral Palsy”. Physical Medicine and Rehabilitation Clinics of North America 20.3 (2009): 469-491.
  10. Dequeker G., et al. “Evolution of self-care and functional mobility after single-event multilevel surgery in children and adolescents with spastic diplegic cerebral palsy”. Developmental Medicine and Child Neurology 60.5 (2018): 505-512.
  11. FDA. Information for healthcare professionals: OnabotulinumtoxinA (marketed as Botox/Botox cosmetic), AbobotulinumtoxinA (marketed as Dysport) and RimabotulinumtoxinB (marketed as Myobloc). 2009. 
  12. Heinen F., et al. “European consensus table 2006 on botulinum toxin for children with cerebral palsy”. European Journal of Paediatric Neurology 10 (2006): 215-225.
  13. Lebarbier P and Penneçot G. “L’infirmité motrice d’origine cérébrale (IMOC)”. Revue de Chirurgie Orthopédique 92 (2006): 393-395.
  14. Mall V., et al . “Treatment of adductor spasticity with BTX-A in children with CP: a randomized, double-blind, placebocontrolled study”. Developmental Medicine and Child Neurology 48.1 (2006): 10-13.
  15. McGinley JL., et al. “Single-event multilevel surgery for children with cerebral palsy: a systematic review”. Developmental Medicine and Child Neurology 54.2 (2012): 117-128.
  16. Novacheck TF., et al. “Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. Surgical technique”. Journal of Bone and Joint Surgery 91.2 (2009): 271-286.
  17. Novak I., et al. “Clinical prognostic messages from a systematic review on cerebral palsy”. Pediatrics 130.5 (2012): 1285-1283.
  18. Rodda JM., et al. “Correction of severe crouch gait in patients with spastic diplegia with use of multilevel orthopaedic surgery”. Journal of Bone and Joint Surgery 88.12 (2006): 2653-2664.
  19. Russo RN., et al. “Upperlimb Botulinum toxin A injection and occupational therapy in children with hemiplegic cerebral palsy identified from a population register: a single-blind, randomized, controlled trial”. Pediatrics 1195 (2007): e1149-1158.
  20. Rutz E., et al. “Stability of the Gross Motor Function Classification System after single-event multilevel surgery in children with cerebral palsy”. Developmental Medicine and Child Neurology 54.12 (2012): 1109-1113.
  21. Scholtes VA., et al. “The combined effect of lower-limb multilevel Botulinum toxin type A and comprehensive rehabilitation on mobility in children with cerebral palsy: a randomized clinical trial”. Archives of Physical Medicine and Rehabilitation 87.12 (2006): 1551-1518.
  22. Sutherland DH., et al. “Double-blind study of botulinum A toxin injections into the gastrocnemius muscle in patients with cerebral palsy”. Gait and Posture 10.1 (1999): 35-38.
  23. Svehlík M., et al. “The influence of age at single-event multilevel surgery on outcome in children with cerebral palsy who walk with flexed knee gait”. Developmental Medicine and Child Neurology 53.8 (2011): 730-735.
  24. Tedroff Kristina., et al. “To switch from Botox to Dysport in children with CP, a real world, dose conversion, cost-effectiveness study”. European Journal of Paediatric Neurology XXX (2018): 1-7.
  25. Wohlfarth K., et al. “Dose equivalence of two commercial preparations of botulinum neurotoxin type A: time for a reassessment?”. Current Medical Research and Opinion 25.7 (2009): 1573-1584.
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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