Intrathecal Baclofen vs. Several Conventional Treatment Options
Bensmail and colleagues (2009; France) modelled a population that was poorly functioning as a result of their spasticity and required assistance for their activities of daily living. This simulated population included individuals with tetraplegia, highly dependent multiple sclerosis, traumatic brain injury (TBI), cerebral palsy and stroke. A decision analytic tree was constructed that focused on treatment success and failure over a 2-year period. The scale used to measure outcome in this model was a combination of Goal Attainment Scale (GAS) that measures patient and caregiver satisfaction and the Ashworth Scale. A successful treatment was defined as an improvement in GAS and a minimum 1-point decrease in the Ashworth score. Rate of success was the primary outcome. Costs included hospital costs, physician visits, drug costs, surgical cost, transportation services, physical treatments, device costs, and home care nursing. In the base case analysis intrathecal baclofen (ITB) had a greater rate of success over conventional treatment. As well over a 2-year time frame the cost of ITB was less than conventional therapy. Thus, in the base case ITB had lower costs and better outcomes compared to conventional therapy (lower costs and better outcomes). A probabilistic sensitivity analysis was conducted to address the uncertainty in the data variables used in the model. This was conducted by running 5000 iterations of the model and selecting values for each data variable in the model from the distributions set where there was uncertainty. The frequency distribution of total medical costs was presented for the ITB and conventional therapy; however, the distribution of cost per effect was not presented. The authors concluded that as a first-line therapy, ITB had the lowest costs and had the highest probability of treatment success. The effectiveness measure in this analysis was patient and caregiver satisfaction combined with patient spasticity.