Botulinum Toxin Type A for the Treatment of Focal Spasticity in Children With Cerebral Palsy in Thailand: A Cost-Utility and Budget Impact Analysis

Objectives Cerebral palsy (CP) causes lifelong functional impairment and societal burden. In Thailand, botulinum toxin type A (BoNT-A) is not reimbursed for CP-related focal spasticity. This study evaluated the cost-utility and budget impact of adding abobotulinumtoxinA (aboBoNT-A) or onabotulinumtoxinA (onaBoNT-A) to standard care (SoC) versus SoC alone. Methods A Markov model (societal perspective; lifetime horizon; 3% annual discount) was used to estimate costs and outcomes for SoC+aboBoNT-A and SoC+onaBoNT-A compared with SoC. Direct medical and nonmedical costs, utility, and transitional probabilities were collected from tertiary hospitals. Treatment efficacies were derived from a network meta-analysis. Deterministic and probabilistic sensitivity analyses were conducted. Lifetime cost, life-years, quality-adjusted life-years (QALYs), and an incremental cost-effectiveness ratio were estimated and assessed against a Thai threshold of 160 000 (US $4468) THB per QALY. A budget impact analysis was conducted using epidemiological estimates and projected uptake rates (30% in year 1, 50% in year 2, and up to 100% thereafter; alternative scenario: 80% from year 3 onward). Results SoC + aboBoNT-A and SoC + onaBoNT-A elicited 0.0033 and 0.0026 QALYs gained with additional costs of US $20 and US $29, yielding incremental cost-effectiveness ratios of US $6003 and US $11 147 per QALY, respectively. Results were most sensitive to direct nonmedical costs among nonresponders. The 5-year budget impact was US $228 961 to $284 805, with similar estimates under conservative uptake. Conclusion Neither SoC + BoNT-A therapy was cost-effective, although both improved spasticity-related quality of life. A 14% price reduction for aboBoNT-A could improve cost-effectiveness. The projected 5-year budget impact was modest across uptake scenarios.