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Intrathecal baclofen therapy in children with intractable spastic cerebral palsy: a cost-effectiveness analysis
M A Hoving1, S M A A Evers, A J H A Ament
1Department of Neurology, University Hospital Maastricht, Maastricht, The Netherlands. mahoving@hotmail.com
Insights
Continuous intrathecal baclofen infusion (CITB) is a cost-effective treatment for children with severe spastic cerebral palsy (CP). This study found CITB improves quality of life and is economically viable within Dutch healthcare standards.
Area of Science:
- Pediatric Neurology
- Health Economics
- Rehabilitation Medicine
Background:
- Intractable spastic cerebral palsy (CP) significantly impacts children's quality of life.
- Continuous intrathecal baclofen infusion (CITB) is an established treatment for spasticity in CP.
- Limited prospective cost-effectiveness data exists for CITB in pediatric CP.
Purpose of the Study:
- To conduct a cost-effectiveness analysis of CITB versus standard care in children with spastic CP.
- To evaluate health effects using quality-adjusted life years (QALYs) and visual analogue scales.
- To determine the economic viability of CITB within the Dutch healthcare system.
Main Methods:
- A prospective, national cost-effectiveness study comparing CITB with standard treatment only.
- Inclusion of 15 children (7-17 years) with severe spastic or spastic-dyskinetic CP (GMFCS Levels III-V).
- Health effects measured via visual analogue scale and QALYs over a 1-year period from a healthcare perspective.
Main Results:
- CITB demonstrated greater effectiveness compared to standard treatment alone.
- The average cost to gain one QALY with CITB was 32,737 euros.
- CITB was found to be more costly than standard care.
Conclusions:
- CITB is a cost-effective intervention for carefully selected pediatric patients with intractable spastic CP.
- The cost per QALY falls below the Dutch willingness-to-pay threshold of 80,000 euros.
- The findings support the use of CITB as a valuable treatment option in pediatric CP management.
Abstract:
In a Dutch national study, we recently established the effectiveness and safety of continuous intrathecal baclofen infusion (CITB) in children with intractable spastic cerebral palsy (CP). Because prospective studies on the cost-effectiveness of CITB in children with spastic CP are lacking, we conducted a cost-effectiveness analysis alongside our prospective national study. We compared the costs and health effects of CITB with those of standard treatment only, from the health care perspective for a 1-year period. Health effects were expressed in terms of a visual analogue scale for individual problems and quality-adjusted life years (QALYs). We included eight females and seven males, aged between 7 and 17 years (mean age 13y 8mo [SD 3y]). Eleven children had spastic CP and four had spastic-dyskinetic CP. One child was clsssified on the Gross Motor Function Classification System at Level III, two at Level IV, and 12 at Level V. CITB was more effective and more costly than standard treatment only. Gaining one QALY cost on average 32,737 euros. We conclude that based on the threshold-willingness to pay for one QALY in the Netherlands (80,000 euros), our results confirm the cost-effectiveness of CITB for carefully selected children with intractable spastic CP.
