Advertisement

PharmacoEconomics

, Volume 15, Issue 4, pp 395–404 | Cite as

Cost Analysis of the Treatment of Severe Spinal Spasticity With a Continuous Intrathecal Baclofen Infusion System

  • Theo PostmaEmail author
  • Dettie Oenema
  • Symon Terpstra
  • Jelte Bouma
  • Hannah Kuipers-Upmeijer
  • Michiel J. Staal
  • Berry J. Middel
Original Research Article Cost Analysis of Spinal Spasticity Treatment

Abstract

Objective: The purpose of our study was to analyse and evaluate the costs of continuous intrathecal baclofen administration as a modality in the treatment of severe spasticity in the Netherlands.

Design: A cost analysis was conducted as part of a prospective, multicentre, multidisciplinary, randomised and placebo-controlled clinical trial. The study covered the period from December 1991 to September 1995. The data on medical consumption and costs were collected over a 3-year period from different sources: administrative databases of health insurance companies, hospital registries and a patient survey. These data were structured by means of a flowchart analysis of the medical decision-making by specialists and general practitioners (GPs). They included data on in- and outpatient care, home care and care in nursing homes.

The cost analysis was conducted using data from 18 patients included in the trial and from 15 so-called ‘match’ patients. The latter group are patients with comparable diseases leading to spasticity and living in comparable circumstances. Next to absolute costs (direct and indirect) of care and treatment for the 2 groups of patients, cost differences between the 2 groups were considered (differential cost analysis).

Setting: Per patient cost data, collected prospectively for 2 years during the phase of clinical evaluation, and retrospectively 1 year before implantation. The data were collected on patients from in- and outpatient care, home care and care in nursing home settings.

Patients and participants: The trial patients (8 men) had a mean age of 46 years; 11 patients had multiple sclerosis and 7 patients had spinal cord injuries. The match patients (7 men) had a mean age of 48 years; 9 patients had multiple sclerosis and 6 patients had spinal cord injuries.

Interventions: Trial patients were treated with a subcutaneously implanted programmable continuous infusion pump (SynchroMed, Medtronic), filled with baclofen (a muscle relaxant) to treat patients with chronic disabling spasticity who did not respond to a maximum dose of oral baclofen, dantrolene and tizanidine.

Main outcome measures and results: An analysis of hospital stay between both groups showed a significant difference during the implantation year. The average number of hospital days per patient in that year in the treated group was 31.5 days and in the match group was 18.7 days. Significant cost differences between both groups in the year that started with pump implantation and the following year can be attributed mostly to the costs of implantation of the pump and related hospitalisation days. The total costs of patient selection, testing, implanting the pump and follow-up amounted to $US28 473 for the first year. Savings must be taken into consideration as well. The savings of direct costs were due to withdrawal of oral medication (estimated annual total of between $US1950 and $US2800 per patient). Indirect savings on employment and nursing home costs, amounted annually to $US1047 and $US5814, respectively.

Scenarios make it possible to consider policy consequences. The case of ‘extending’ the indications for this treatment to a larger population has been calculated and visualised.

Conclusions: The costs of the therapy (continuous intrathecal infusion of baclofen) can be attributed mostly to implantation of the pump and related hospitalisation days. Savings originated from withdrawal of oral medication, job preservation and avoidance or delay of admission to a nursing home.

Keywords

Spinal Cord Injury Adis International Limited Baclofen Dantrolene Match Group 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Albright L, Barron A, Fasick MP, et al. Continuous intrathecal baclofen infusion for spasticity of cerebral origin. JAMA 1993; 270: 247–57CrossRefGoogle Scholar
  2. 2.
    Coffey RJ, Cahill D, Steers W, et al. Intrathecal baclofen for intractable spasticity of spinal origin: results of a long-term multicentre study. J Neurosurg 1993; 78: 226–32PubMedCrossRefGoogle Scholar
  3. 3.
    Loubser PG, Narayan ChRK, Dandin KJ, et al. Continuous infusion of intrathecal baclofen: long-term effects on spasticity in spinal cord injury. Paraplegia 1991; 29: 48–64PubMedCrossRefGoogle Scholar
  4. 4.
    Meythaler JM, Steers WD, Tuel SM, et al. Continuous intrathecal baclofen in spinal cord spasticity. Am J Phys Med Rehabil 1992; 71: 321–7PubMedCrossRefGoogle Scholar
  5. 5.
    Müller H, Zierski J, Dralle D, et al. Intrathecal baclofen in spasticity. In: Müller H, Zierski J, Penn RD, editors. Local spinal therapy of spasticity. Berlin-Heidelberg: Springer Verlag, 1988CrossRefGoogle Scholar
  6. 6.
    Nance P, Schryvers O, Schmidt B, et al. Intrathecal baclofen therapy for adults with spinal spasticity: therapeutic efficacy and effect on hospital admissions. Can J Neurol Sci 1995; 22: 22–9PubMedGoogle Scholar
  7. 7.
    Ochs G, Delhaas EM. Long-term experience with intrathecal use of baclofen in severe spasticity. In: Lakke JPWF, Delhaas EM, Rutgers AWF, editors, Parental drug therapy in spasticity and Parkinson’s disease. Carnforth: The Parthenon Publishing Group Limited, 1992Google Scholar
  8. 8.
    Patterson, V, Watt M, Byrnes D, et al. Management of severe spasticity with intrathecal baclofen delivered by a manually operated pump. J Neurol Neurosurg Psychiatry 1994; 57: 582–5PubMedCrossRefGoogle Scholar
  9. 9.
    Penn RD. Intrathecal baclofen for spasticity of of spinal origin: seven years of experience. J Neurosurg 1992; 77: 236–40PubMedCrossRefGoogle Scholar
  10. 10.
    Saltuari L, Kronenberg M, Marosi MJ, et al. Indication, efficiency and complications of intrathecal pump supported baclofen treatment in spinal spasticity. Acta Neurol [Quad] (Napoli) 1992; 3: 187–94Google Scholar
  11. 11.
    Steinbok P, Daneshvar H, Evans D, et al. Cost analysis of continuous intrathecal baclofen versus selective functional posterio rhizotomy in the treatment of spastic quadriplegia associated with cerebral palsy. Pediatr Neurosurg 1995; 22: 255–65PubMedCrossRefGoogle Scholar
  12. 12.
    Teddy P, Jamous A, Gardner B, et al. Complications of intrathecal baclofen delivery. Br J Neurosurg 1992; 6: 115–8PubMedCrossRefGoogle Scholar
  13. 13.
    Gianino JM, York MM, Paice JA, et al. Quality of life: effect of reduced spasticity from intrathecal baclofen. J Neurosc Nurs 1998; 30 (1): 47–54CrossRefGoogle Scholar
  14. 14.
    Staal MJ, Bouma J, Kuipers-Upmeijer H, et al. Treatment of severe spinal spasticity with an intrathecal baclofen infusion system [in Dutch]. Groningen: Academic Hospital Groningen, 1996Google Scholar
  15. 15.
    Middel B, Kuipers-Upmeijer H, Bouma J, et al. Effect of intrathecal baclofen delivered by an implanted programmable pump on health related quality of life in patients with severe spasticity. J Neurol Neurosurg Psychiatry 1997; 63: 204–9PubMedCrossRefGoogle Scholar
  16. 16.
    Drummond MF, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford Medical Publications, 1987Google Scholar
  17. 17.
    Postma ThJBM. The usefulness of cost effectiveness analyses for policy support in health care. Know Policy 1995; 8: 33–44CrossRefGoogle Scholar
  18. 18.
    Udvarhelyi IS, Colditz GA, Rai A, et al. Cost-effectiveness and cost-benefit analyses in the medical literature. Ann Intern Med 1992; 116: 238–44PubMedGoogle Scholar
  19. 19.
    Bombardier C, Eisenberg J. Looking into the chrystal ball: can we estimate the lifetime cost of rheumatoid arthritis? J Rheumatol 1985; 12: 201–4PubMedGoogle Scholar
  20. 20.
    Verhoeff BM, Birnie EB. Maatschappelijke kosten van chronische ziekten: verslag van een oriënterend onderzoek. Rotterdam: Nederlands Economisch Instituut, 1992Google Scholar
  21. 21.
    Siegel S, Castellan NJ. Non-parametric statistics for the behavioural sciences. New York (NY): McGraw-Hill, 1988Google Scholar
  22. 22.
    Van der Heijden K. Scenarios: the art of strategic conversation. Chichester: Wiley, 1996Google Scholar

Copyright information

© Springer International Publishing AG 1999

Authors and Affiliations

  • Theo Postma
    • 1
    Email author
  • Dettie Oenema
    • 2
  • Symon Terpstra
    • 3
  • Jelte Bouma
    • 3
  • Hannah Kuipers-Upmeijer
    • 2
  • Michiel J. Staal
    • 4
  • Berry J. Middel
    • 3
  1. 1.Faculty of EconomicsUniversity of GroningenGroningenThe Netherlands
  2. 2.Department of NeurologyUniversity Hospital GroningenGroningenThe Netherlands
  3. 3.Northern Centre of Healthcare Research, University of GroningenGroningenThe Netherlands
  4. 4.Department of NeurosurgeryUniversity Hospital GroningenGroningenThe Netherlands

Personalised recommendations