The Estimated Cost of Managing Focal Spasticity: A Physician Practice Patterns Survey

The purpose of this study was to estimate the overall cost of managing focal spas ticity after stroke (CVA) and traumatic brain injury (TBI) and the cost impact of in dividual treatments. Sixty physicians described management strategies over six treat ment visits for four focal spasticity case studies (one upper and one lower extremity case for CVA and TBI). Mean and median per-case costs were determined across physi cians ; median per-case costs of physicians who did or did not report use of specific treat ments were compared. Mean per-case costs of managing spasticity are as follows: CVA upper, $5,131; CVA lower, $5,384; TBI upper, $14,615; and TBI lower, $13,966. Me dian per-case costs for strategies including botulinum toxin type A (BTX-A) were less than those without BTX-A in CVA upper; median costs for strategies including oral baclofen were more than those without baclofen in CVA lower. Fewer total treat , ments were reported with BTX-A than without; more total treatments were reported with baclofen than without. No individual treatment had a significant impact on me dian treatment costs in TBI. Physician-reported spasticity management costs are sub stantial. Despite higher drug costs for BTX-A compared with oral therapies like ba clofen, strategies for managing spasticity in CVA that include BTX-A may cost less than those without BTX-A. Key Words: Spasticity—Stroke—Traumatic brain in jury—Botulinum toxin type A—Baclofen.