Estimating the cost consequence of the early use of botulinum toxin in post-stroke spasticity: Secondary analysis of a randomised controlled trial.

Only 93 participants were analysed, and the study was not powered to assess cost-effectiveness. Some resource-use data were missing, including the number of therapist contacts after discharge to the community. The analysis included health costs but not all social costs; unpaid family care was not recorded. Patients were not monitored long term, so long-term contracture costs were estimated using a mean cost of £9193. The trial enrolled only patients with an Action Research Arm Test grasp-score of 2 or less and spasticity within six weeks of a first stroke, so the results may not apply to all people with post-stroke spasticity. The significant contracture cost finding occurred alongside a non-significant overall cost result, so it does not establish that the intervention was cost-saving.

The authors declared no potential conflicts of interest. The study was funded by the National Institute for Health Research under its Research for Patient Benefit Programme. Allergan provided the drug and an unrestricted educational grant, but the paper states it had no role in study design, data collection, data analysis, data interpretation, or writing. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Do not conclude that early botulinum toxin is proven cost-effective or will save money. The overall cost difference was not statistically significant, the study was not powered for cost-effectiveness, and long-term contracture costs were estimated rather than directly observed.