Date Presented 04/22/2023
Patients with poststroke spasticity experienced higher mean health care costs than those with stroke without spasticity. Earlier identification to optimize treatment of spasticity represents an opportunity for cost savings in health care systems.
Primary Author and Speaker: Jonathan Bouchard
Contributing Authors: Michael Hull, Ruthwik Anupindi, Jing He, Mitchell DeKoven, Jumaah Goldberg, Jonathan Bouchard
PURPOSE: Post-stroke spasticity (PSS), a common sequela of stroke, occurs in ∼25-43% of patients between 2 weeks–3 months following a stroke. Here we examine the occurrence of PSS, treatment patterns, healthcare resource utilization, and costs in patients over 2 years.
DESIGN: Analyses were conducted using healthcare claims from the IQVIA PharMetrics® Plus database of commercially/ self-insured members from 10/01/2015–01/31/2021.
METHOD: Patients were selected based on 2 ICD-10 diagnosis codes for stroke requiring an inpatient stay (index date) with 12 months of continuous enrollment with medical/pharmacy benefits before the index date (pre-index) and 24 months starting on the index date (post-index). Patients with prior stroke or spasticity were excluded. A generalized linear model was developed to estimate cost ratios between patients with/without PSS.
RESULTS: Overall, 7851 patients who fulfilled study criteria were treated with PT/OT (n=3746; 47.7%), muscle relaxants (n=887;11.3%), or botulinum toxin A (BoNT-A) (n=60; 0.8%). Of these, 975 (12.4%) met the post-index definition of PSS. Median time to codes identifying PSS was 213 days. Those treated with BoNT-A received up to 3 injections, starting 253 days post-stroke (median), and 68.0% remained on treatment after 12 months. Among those with PSS, mean all-cause healthcare costs were $62,875 vs $44,472 for patients without PSS (p<0.001), representing 39.6% higher adjusted all-cause healthcare costs among patients with PSS compared to patients without (p<0.001).
CONCLUSIONS: PSS identified via this analysis had a lower rate and later timing than in previous epidemiological studies, possibly due to delayed and/or underreporting in clinical practice. PSS patients utilized numerous treatment modalities and experienced higher mean all-cause healthcare costs than those without spasticity. Earlier identification to optimize treatment of PSS may represent an opportunity for cost savings within managed healthcare systems.
Virani S, et al. Circulation. 2021;143:e254-743.
Katoozian L, et al. J Natl Med Assoc. 2018;110(6):547-552.
Simon O, et al. Eur J Phys Rehabil Med. 2010;46:401-410.
Hull M, et al. JMCP. 2021;27(10a):S92-S93.