{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T11:39:03Z","timestamp":1791545943390,"version":"4.3.4"},"reference-count":42,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T00:00:00Z","timestamp":1736121600000},"content-version":"unspecified","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004397","name":"Ministry of Public Health","doi-asserted-by":"publisher","award":["Medicine Regulations Division, Food and Drug Admin"],"award-info":[{"award-number":["Medicine Regulations Division, Food and Drug Admin"]}],"id":[{"id":"10.13039\/501100004397","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,12,8]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the cost-utility of botulinum toxin A (BoNT-A) for treating upper limb (UL) and lower limb (LL) post-stroke spasticity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Using a Markov model, adopting a societal perspective and a lifetime horizon with a 3% annual discount rate, the cost-utility analysis was conducted to compare BoNT-A combined with standard of care (SoC) with SoC alone. Costs, utilities, transitional probabilities and treatment efficacy were derived from 5-year retrospective data from tertiary hospitals and meta-analysis. Uncertainty analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Tertiary hospitals in Thailand.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Cohort of post-stroke patients aged 55 years with UL or LL spasticity and a Modified Ashworth Scale score \u22651+.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>BoNT-A (abobotulinumtoxinA: aboBoNT-A, onabotulinumtoxinA: onaBoNT-A or prabotulinumtoxinA: praBoNT-A) combined with SoC versus SoC alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>Expected life years, quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratios (ICERs), considering a cost-effectiveness threshold of 160 000 THB (US$4468) per QALY gained.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The combination of aboBoNT-A and SoC yielded the highest QALYs gained (0.013 for UL and 0.11 for LL), followed by onaBoNT-A and SoC and praBoNT-A and SoC. The additional costs for treating UL and LL cases were highest for onaBoNT-A US$75 and US$95, respectively, followed by aboBoNT-A and praBoNT-A. ICER values for treating UL with aboBoNT-A, onaBoNT-A and praBoNT-A ranged from US$4669 to US$7541 per QALY. For LL treatments, aboBoNT-A and onaBoNT-A had ICER values ranging from US$7072 to US$15\u2009182 per QALY. Integrating BoNT-A treatment delivery into the healthcare system would require a budget outlay of approximately US$413 246\u2013US$966\u2009103 that may vary annually by an additional US$50 260\u2013US$335\u2009064.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>BoNT-A effectively reduces focal spasticity and improves quality of life in post-stroke patients. However, its cost-effectiveness in Thailand necessitates price negotiations as a condition for inclusion in the pharmaceutical reimbursement list.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-090701","type":"journal-article","created":{"date-parts":[[2025,1,6]],"date-time":"2025-01-06T20:41:15Z","timestamp":1736196075000},"page":"e090701","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Botulinum toxin type A for the treatment of patients with post-stroke spasticity in Thailand: cost-utility and budget impact analysis"],"prefix":"10.1136","volume":"15","author":[{"given":"Phorntida","family":"Hadnorntun","sequence":"first","affiliation":[{"name":"Siriraj Health Policy Unit, Mahidol University Faculty of Medicine Siriraj Hospital, Bangkok, 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