This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by de Lissovoy, G. Articles by Edgar, T. Search for Related Content PubMed PubMed Citation Articles by de Lissovoy, G. Articles by Edgar, T. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Social Bookmarking                   What's this?

Cost-effectiveness of Intrathecal Baclofen Therapy for the Treatment of Severe Spasticity Associated With Cerebral Palsy

United BioSource Corporation, Bethesda, Maryland, gregory.delissovoy{at}unitedbiosource.com

Louis S. Matza, PhD

United BioSource Corporation, Bethesda, Maryland

Hannah Green, MPH

Dana-Farber Cancer Institute, Boston, Massachusetts

Meghan Werner, MPP

United BioSource Corporation, Bethesda, Maryland

Terence Edgar, MD, FAAP, FAAEM

Prevea Clinic, Green Bay, Wisconsin

Spasticity is relatively common among children with cerebral palsy. This condition can be painful, can severely impair a child's ability to perform basic tasks, and can place an enormous emotional and financial burden on the family. Intrathecal baclofen delivered via an implantable pump is an effective treatment option for children unresponsive to oral medication and needing generalized motor control. However, the initial investment for the delivery device and its surgical placement can be a barrier to access. A cost-effectiveness analysis of intrathecal baclofen for adults in the British health care system concluded that intrathecal baclofen offered good value for the money. No similar analysis of intrathecal baclofen has been conducted in the context of the US health care system, and no study has specifically examined cost-effectiveness of intrathecal baclofen in a pediatric population. The aim of this article is to assess the cost-effectiveness of intrathecal baclofen among children with severe spasticity of cerebral origin who have not responded to less invasive treatments such as oral medications relative to alternative medical and surgical therapy. The authors used mathematical modeling and computer simulation to estimate the incremental cost per quality-adjusted life-year for identical cohorts of children treated with intrathecal baclofen or alternative therapy over a 5-year episode of treatment. Data on treatment costs representative of these children were derived from a health insurance claims database that included both commercial and Medicaid data. Utility values used to construct quality-adjusted life-years were obtained from a panel of expert clinicians who used the Health Utilities Index—2 to rate health states associated with the course of treatment. On average, intrathecal baclofen therapy increased the 5-year cost of treatment by $49 000 relative to alternative treatment. However, this was accompanied by an average gain of 1.2 quality-adjusted life-years. The net result was an incremental cost-effectiveness ratio of $42 000 per quality-adjusted life-year, a figure well within the $50 000 to $100 000 range that is widely accepted as offering good value for the money.

Key Words: spasticity • baclofen • cost-effectiveness

Journal of Child Neurology, Vol. 22, No. 1, 49-59 (2007)
DOI: 10.1177/0883073807299976


CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				D. Bensmail, A.B. Ward, J. Wissel, F. Motta, L. Saltuari, J. Lissens, S. Cros, and A. Beresniak Cost-effectiveness Modeling of Intrathecal Baclofen Therapy Versus Other Interventions for Disabling Spasticity Neurorehabil Neural Repair, July 1, 2009; 23(6): 546 - 552. [Abstract] [PDF]

				S. Petrou and E. Kupek Estimating Preference-Based Health Utilities Index Mark 3 Utility Scores for Childhood Conditions in England and Scotland Med Decis Making, May 1, 2009; 29(3): 291 - 303. [Abstract] [PDF]