Introduction: Post-stroke spasticity (PSS) occurs in ~25-43% of patients between 2 weeks and 3 months following a stroke. This retrospective claims study examined the occurrence of spasticity, treatment patterns, healthcare resource utilization, and healthcare costs among patients who experienced a stroke over a 2-year period.
Methods: Analyses were conducted using healthcare claims from the IQVIA PharMetrics Plus database of commercially/self-insured members from 2015 to 2021. Patients were selected based on two International Classification of Diseases, 10th revision diagnosis codes for stroke requiring an inpatient stay (index date) with continuous enrollment with medical/pharmacy benefits 12 months before (pre-index) and 24 months starting on the index date (post-index). PSS was defined by a diagnosis code for spastic hemiplegia or muscle contracture starting ≥ 7 days post-index, or claims indicating PSS treatment [botulinum toxin A (BoNT-A) or muscle relaxants] any time in the post-index period. A generalized linear model was developed to estimate cost ratios between patients with and without PSS.
Results: Overall, 7851 patients fulfilled study criteria; 47.7% were treated with physical or occupational therapy, 11.3% with muscle relaxants, and 0.8% with BoNT-A; 12.4% met the post-index definition of PSS; 84.2% were identified using muscle relaxant or BoNT-A codes, 6.6% using diagnosis codes, and 9.2% using both. Median time to codes identifying PSS was 213 days. Patients treated with BoNT-A received an average of three treatments, starting 253 days (median) post-stroke. Mean all-cause healthcare costs were US$62,875 among patients with PSS versus $44,472 among patients without (P < 0.001), representing 39.6% higher adjusted all-cause healthcare costs among patients with PSS versus patients without PSS.
Conclusion: Patients with PSS utilized numerous treatment modalities and experienced higher mean all-cause healthcare costs than did those without PSS. Earlier identification to optimize treatment of PSS may represent an opportunity for cost savings within managed healthcare systems.
Keywords: Botulinum toxin type A; Healthcare costs; Healthcare resource utilization; Post-stroke spasticity; Real-world evidence.
Each year, about 795,000 people in the US experience a stroke, of whom an estimated 25% or more go on to develop spasticity, an abnormal, involuntary muscle tightness due to extended muscle contraction. Treatment guidelines, which help healthcare providers decide the best way to treat people with a specific condition, recommend botulinum toxin type A for individuals with post-stroke spasticity. This study assessed treatment patterns, healthcare use, and healthcare costs in US patients with post-stroke spasticity over a 2-year period. Results showed that spasticity was first identified in patients’ medical records using relevant diagnosis codes or prescribed drug therapies about 8 months after a stroke. Only 6.6% of patients who were treated with drug therapy for spasticity were given botulinum toxin type A. Patients with stroke and spasticity needed more healthcare visits than those with stroke but without spasticity. Patients with spasticity also had significantly higher healthcare costs than those without spasticity (average per patient: $62,875, compared with $44,472). Hospital stays accounted for most of the costs (average per patient: $40,243 for those with spasticity, compared with $27,426 for those without spasticity). The results of this real-world study suggest that healthcare costs could potentially be reduced if spasticity after stroke were identified sooner and treated effectively. While our study found an association between healthcare costs and post-stroke spasticity, it’s important to note that the patients in this study had managed care plans, so the results might not apply to patients with other types of health insurance.
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