Modelling Long-Term Outcomes and Risk of Death for Patients with Post-Stroke Spasticity Receiving Abobotulinumtoxina Treatment and Rehabilitation Therapy.
Klemens Fheodoroff, Natalya Danchenko, John Whalen and 7 others
PMID 35844200WHAT IT FOUND
Modelled post-stroke spasticity care suggested adding aboBoNT-A to rehabilitation may reduce all-cause mortality risk by 8.8% and be cost-effective in the UK, but this is a model, not tested in patients.
Key findings
01In the model, adding aboBoNT-A to rehabilitation was associated with an 8.8% reduction in all-cause mortality risk and a 12.8% relative increase in discounted life-years.
02The modelled incremental cost per quality-adjusted life-year was £24,602, below the UK £30,000 threshold.
03In probabilistic sensitivity analysis, there was a 73% likelihood that aboBoNT-A plus rehabilitation was cost-effective at £30,000.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The mortality benefit was modelled, not measured in patients receiving aboBoNT-A. No studies evaluated the impact of aboBoNT-A injections on all-cause death or cardiovascular events. The model relied on a single randomized controlled study for the effect of aboBoNT-A on functional independence. UK resource-use and quality-of-life data for post-stroke spasticity were not available, so the model used data from an Italian cost-utility analysis. Survival rates for stroke survivors with spasticity were not captured, and the model assumed they were the same as for stroke survivors without spasticity. The model assumed treatment continued for 10 years with injections every 12 weeks, which may not match usual practice. The model did not explore pain, caregiver burden, treatment adherence or discontinuation.
The easy way to misread this
Do not conclude that aboBoNT-A injections have been shown to reduce death in post-stroke spasticity. The mortality reduction was modelled from functional independence scores, and the paper states that no studies evaluated the impact of aboBoNT-A injections on all-cause death or cardiovascular events.