{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:29:20Z","timestamp":1760059760679,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:00:00Z","timestamp":1751587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1079542","106762"],"award-info":[{"award-number":["1079542","106762"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","award":["1079542","106762"],"award-info":[{"award-number":["1079542","106762"]}],"id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Toxins"],"abstract":"<jats:p>Spasticity is a persistent and debilitating consequence of stroke and effective rehabilitation is a healthcare priority. Botulinum neurotoxin A (BoNT-A) with supportive therapy has increasingly been embedded within clinical practice for treatment of post-stroke spasticity. But the evidence for this approach has hitherto been limited to the findings of a limited number of small trials. The InTENSE trial was undertaken specifically to provide high-quality clinical trial evidence focusing on the effect of BoNT-A and adjunctive therapy on upper limb spasticity. While the clinical trial did not detect a significant impact upon clinical outcomes, there remains a need to evaluate any impact on the broader use of healthcare resources and overall cost-effectiveness. A detailed cost\u2013utility analysis of the InTENSE trial was undertaken. The costs over the 12-month follow-up period were compared with quality-adjusted life years (QALY) gained using utilities generated from the EQ-5D three level (EQ-5D-3L) instrument. There were no significant differences in QALY gained between the intervention and control groups identified, or in the majority of health and community care costs. The Incremental Cost-Effectiveness Ratio per QALY gained was estimated at AU $63,947.11 (Australian dollars), which is well above accepted thresholds for cost-effectiveness in Australia. The study was unable to identify evidence for the cost-effectiveness of treatment approaches combining BoNT-A with adjunctive therapy.<\/jats:p>","DOI":"10.3390\/toxins17070341","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T11:20:11Z","timestamp":1751628011000},"page":"341","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Economic Evaluation of the InTENSE Program of Therapy Alongside Botulinum Neurotoxin a for the Rehabilitation of Chronic Upper Limb Spasticity"],"prefix":"10.3390","volume":"17","author":[{"given":"Rachel","family":"Milte","sequence":"first","affiliation":[{"name":"Caring Futures Institute, Flinders University, Adelaide, SA 5001, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4796-3456","authenticated-orcid":false,"given":"Jia","family":"Song","sequence":"additional","affiliation":[{"name":"Caring Futures Institute, Flinders University, Adelaide, SA 5001, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7051-7548","authenticated-orcid":false,"given":"Sean","family":"Docking","sequence":"additional","affiliation":[{"name":"School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julie","family":"Ratcliffe","sequence":"additional","affiliation":[{"name":"Caring Futures Institute, Flinders University, Adelaide, SA 5001, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0147-047X","authenticated-orcid":false,"given":"Ian D.","family":"Cameron","sequence":"additional","affiliation":[{"name":"Sydney School of Health Sciences, University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Crotty","sequence":"additional","affiliation":[{"name":"College of Medicine and Public Health, Flinders University, Adelaide, SA 5001, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1369-5721","authenticated-orcid":false,"given":"Louise","family":"Ada","sequence":"additional","affiliation":[{"name":"Sydney School of Health Sciences, University of Sydney, Sydney, NSW 2006, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5910-7927","authenticated-orcid":false,"given":"Coralie","family":"English","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of Newcastle, Callaghan, NSW 2308, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2066-8345","authenticated-orcid":false,"given":"Natasha A.","family":"Lannin","sequence":"additional","affiliation":[{"name":"Department of Neuroscience, Monash University, Alfred Health, Melbourne, VIC 304, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,4]]},"reference":[{"key":"ref_1","unstructured":"Global Burden of Disease 2021 Causes of Death Collaborators (2024). 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