Inequalities in pharmacologic treatment of spasticity in Sweden – health economic consequences of closing the treatment gap

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 scenario^a	~ 45,000	4%
Excl. indirect costs	~ 39,000	4%
Association between spasticity and costs^b
- 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

ISSN: 2191-1991