Cost effectiveness and impact on quality of life of abobotulinumtoxinA and onabotulinumtoxinA in the treatment of children with lower limb spasticity in Canada

Abstract

Background: Injectable botulinum neurotoxins are a mainstay of treatment for pediatric spasticity. AbobotulinumtoxinA and onabotulinumtoxinA are both injectable toxin therapies used to treat pediatric lower limb (PLL) spasticity in Canada. The objective of this study was to assess the cost-effectiveness of abobotulinumtoxinA vs. onabotulinumtoxinA in the treatment of PLL spasticity in Canada.

Methods: A probabilistic Markov cohort model with a 2-year time horizon was developed, with health states defined by response to therapy, as characterized by the goal attainment scale (GAS). Based on randomized controlled trial evidence, response to therapy was similar or higher for abobotulinumtoxinA relative to onabotulinumtoxinA; uncertainty was incorporated into model parameters, however, as the two therapies have not been compared head-to-head. Canadian resource use and cost data were incorporated.

Results: In the base case, abobotulinumtoxinA generated 1.48 quality-adjusted life years over the model time horizon, compared to 1.47 for onabotulinumtoxinA. AbobotulinumtoxinA was associated with cost savings of $123 CAD, reflecting lower costs in both medication acquisition and health services. The estimated improvement to quality of life and reduced costs result in an estimate of economic dominance for abobotulinumtoxinA over onabotulinumtoxinA. This dominant result persisted across probabilistic and scenario analyses.

• Key points for decision makers

• Based on a review of available clinical evidence, abobotulinumtoxinA was found to have significant and/or numerical efficacy benefits to onabotulinumtoxinA on functional outcomes (Goal Attainment Scale) and tone (Modified Ashworth Scale) and in the treatment of pediatric lower limb spasticity

• In this cost-effectiveness analysis, abobotulinumtoxinA was found to be associated with greater quality-adjusted life years and lower costs than onabotulinumtoxinA (economically dominant)

• A limitation of this analysis was the uncertainty around key parameters. Specifically, the lack of head-to-head comparison data for the two therapies, and variable data regarding likely onabotulinumtoxinA dosing in PLL in clinical practice. However, across a range of plausible scenarios, the economic dominant result remained.

     

Choice experiments,site similarity and benefits transfer

Choice experiments are designed to account for variations in environmental resources and site characteristics, as well as potential implications of these variations for willingness to pay. As a result, choice experiment results may be well suited for benefits transfer. It is unclear, however, whether the flexibility of choice experiments renders the similarity of study and transfer sites less critical for transfer validity. Drawing from identical choice experiments conducted in different Rhode Island communities, this model assesses the extent to which error in function-based benefits transfer is related to the similarity of communities across a variety of observable dimensions. Results suggest that site similarity, at least across some dimensions, influences the validity of choice experiment benefits transfers. However, the use of some measures of similarity as indicators of transfer error may provide misleading results.     

An analysis of international business-to-business relationships based on the Commitment-Trust theory

Business-to-business relationships are characterized by an exchange between two or more parties. Research has identified several factors that enhance marketing and management in business relationships, mainly with a focus on large manufacturing firms. However, less is known about how service firms develop and maintain international relations during the establishment of a business. To analyze the relevance of the key mediating variable (KMV) model [J. Mark. 58 (1994) 20-38.], which maintains that business-to-business relationship requires commitment and trust, interviews were conducted with five different service entrepreneurs in Sweden, Australia and the UK. The findings demonstrate the importance of commitment, trust, relation termination costs and benefits, shared values and communication between the exchange partners.