COST-EFFECTIVENESS OF INTRATHECAL BACLOFEN THERAPY FOR TREATMENT OF SEVERE SPASTICITY ASSOCIATED WITH CEREBRAL PALSY

Objectives: Assess the cost-effectiveness of ITB among children with severe spasticity of cerebral origin that has not responded to less invasive treatments such as oral medications relative to alternative medical and surgical therapy.

Methods: We used mathematical modeling and computer simulation to estimate the incremental cost per quality-adjusted life year (QALY) for identical cohorts of children treated with ITB or alternative therapy over a five-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 QALYs were obtained from a panel of expert clinicians who used the Health Utilities Index version 2 (HUI-2) to rate health states associated with the course of treatment.

Results: On average, ITB therapy increased the 5 year cost of treatment by $49,000 relative to alternative treatment. However, this was accompanied by an average gain of more than 1 QALY. Net result was an incremental cost-effectiveness ratio of $42,000 per QALY, a figure well within the $50,000-$100,000 range that is widely accepted as offering good value for money. Conclusion: In an era of increasingly constrained medical resources, clinical efficacy alone may not be sufficient to justify third-party coverage and payment for a particular therapy. The larger question is whether the benefits of intervention outweigh the opportunity cost in terms of resources that could be available for alternative care. Our results indicate that ITB delivered via implantable pump in appropriately selected pediatric patients offers good value for money based on widely accepted measures of cost-effectiveness.