Cost analysis of botulinum therapy of spastic forms of cerebral palsy in Ukraine

Abstract

Cerebral palsy (CP) represents a group of disorders of the mechanisms of movement and body position, causing limitations of activity, which are caused by non-progressive damage to the developing brain, fetus or child. About 80% of cases are spastic forms of cerebral palsy. Along with motor rehabilitation, the use of botulinum toxin type A (BoNT-A) is considered one of the main methods of treatment of choice for focal spastic and dystonic syndromes, regardless of their etiology. At present, there are no studies in Ukraine on the analysis of the costs of using drugs based on BoNT-A, taking into account the recommended dose and frequency of administration.
 The aim of the work. Carrying out an analysis of minimizing the cost of botulinum therapy for spastic forms of cerebral palsy in patients aged two years and older.
 The annual dosage and frequency of administration of abobotulotoxin and onabotolutoxin for the treatment of dynamic equinus deformity of the foot caused by focal spasticity due to cerebral palsy in children over two years of age were obtained from the instructions for use. The cost of abobotulotoxin and onabotolutoxin was obtained from the Register of Wholesale Prices of the Ministry of Health of Ukraine.
 Cost analysis for a model cohort of children in different weight categories showed that abobotulotoxin 500 U will be the least expensive treatment technology in the weight category of 21–33 kg at a dosage of 15 U/kg in the treatment of diplegia. Abobotulotoxin 300 U is most rationally used in weight categories 10–20 kg and 34–40 kg with a dosage of 15 U/kg in the treatment of hemiplegia and in the weight category 17–20 kg with a dosage of 30 U/kg in the treatment of diplegia. Weight categories were identified in which the costs of using abobotulotoxin 300 U and abobotulotoxin 500 U were equal to and less than the costs of onabotolutoxin treatment.
 The study was the first to analyze the cost of botulinum therapy, which identified the benefits of abobotulotoxin in the symptomatic treatment of hemiplegia and diplegia in cerebral palsy in the focus of different weight groups of children. Possible variability in the dosage and frequency of administration of onabotolutoxin per year indicates the relevance of collecting additional information on the application in real clinical practice and further pharmacoeconomic studies.