Background The Swedish Healthcare Act states that patients should have equal access to healthcare. This study addresses at how this translates to pharmacological treatment of adult spasticity, including injections with botulinum toxin A (BoNT-A) and pumps for intrathecal baclofen (ITB). To address potential economic incentives for treatment differences, the results are also set into a health economic perspective. Thus, the current study provides a detailed and comprehensive overview for informed decision- and policymaking. Methods Botulinum toxin use was retrieved from sales data. Clinical practice regarding mean BoNT-A treatment dose and proportion used for spasticity indication were validated in five county councils, while the number of ITB pumps were mapped for all county councils. Published costs and quality of life data was used for estimating required responder rates for cost-balance or cost-effectiveness. Results The proportion of patients treated with BoNT-A varied between 5.8% and 13.6% across healthcare regions, with a mean of 9.2% on a national level. The reported number of ITB pumps per 100,000 inhabitants varied between 3.6 and 14.1 across healthcare regions, with a national mean of 6/100,000. The estimated incremental cost for reaching treatment equity was EUR 1,976,773 per year for BoNT-A and EUR 3,326,692 for ITB pumps. Based on expected cost-savings, responder rates ranging between 4% and 15% cancelled out the incremental cost for BoNT-A. Assuming no cost-savings, responder rates of 14% or 36% was required for cost-effectiveness. Conclusions There is a marked variation in pharmacologic treatment of adult spasticity in Sweden. Overall, the results indicate an underuse of treatment and need for harmonisation of clinical practice. Furthermore, the incremental cost for reaching treatment equity is likely to be offset by spasticity-associated cost-savings.

中文翻译：

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瑞典的痉挛性药物治疗不平等-缩小治疗差距对健康的经济影响。

背景技术《瑞典医疗保健法》规定，患者应享有平等的医疗保健机会。这项研究探讨了这如何转化为成人痉挛的药物治疗，包括注射肉毒杆菌毒素A（BoNT-A）和鞘内注射巴氯芬（ITB）的泵。为了解决治疗差异的潜在经济诱因，还将结果纳入卫生经济学的角度。因此，本研究为知情决策和决策提供了详细而全面的概述。方法从销售数据中检索肉毒杆菌毒素的使用。在五个县议会中验证了有关BoNT-A平均治疗剂量和用于痉挛指示的比例的临床实践，同时为所有县议会绘制了ITB泵的数量。已发布的成本和生活质量数据用于估算成本平衡或成本效益所需的响应者比率。结果在整个医疗保健区域中，接受BoNT-A治疗的患者比例在5.8％和13.6％之间变化，在全国范围内平均为9.2％。据报告，在整个医疗保健地区，每100,000名居民中ITB泵的数量在3.6到14.1之间变化，全国平均值为6 / 100,000。BoNT-A每年达到治疗公平所需的估计增量成本为1,976,773欧元，ITB泵则为3,326,692欧元。根据预期的成本节省，响应者比率介于4％和15％之间，抵消了BoNT-A的增量成本。假设不节省成本，则成本效益需要14％或36％的响应率。结论瑞典成人痉挛的药物治疗存在显着差异。总体而言，结果表明治疗方法使用不足，需要协调临床实践。此外，达到治疗公平性所增加的成本很可能会被与痉挛相关的成本节省所抵消。