Article

Intramuscular injection of botulinum toxin (BoNTA) is one of the
primary treatments for focal spasticity. This treatment is considered costly and
the level of reimbursement by health insurance has been decreasing in many
countries for several years. The aim of this study was to determine the real cost
of treating spasticity with BoNTA and to compare this with the level of
reimbursement by the national health insurance in France in 2008 and with a new
fee, specific to the injection of BoNTA in ambulatory services. METHOD: A
single-center, retrospective study using the 2008 database from a French
secondary-care day-hospital unit (treating spasticity in adults with sequelae of
stroke, multiple sclerosis or traumatic brain injuries). The level of
reimbursement by the French ministry of health for BoNTA treatment for adults
with spasticity constituted the "calculated cost" and corresponded to the
hospital's "budget". The "real cost" (incurred by the hospital) included the sum
of staffing and material costs as well as the number of toxin vials used. The
calculated costs for 2009 and 2013 were based on the levels of reimbursement
during those years. The difference between real and calculated cost for 2009 and
2013 was estimated considering that the real cost of 2008 was stable. RESULTS: In
2008, 364 patients received BoNTA, resulting in 870 day-hospital admissions. The
calculated cost was 459,056euro/year and the real cost was 567,438euro/year
(equivalent to 4.27euro/day/patient). The total budget deficit (hospital income
minus hospital costs) was 108,383euro. The deficit was estimated at 222,892euro
in 2009 and 241,188euro in 2013. CONCLUSION: The daily cost of BoNTA treatment
for spasticity is reasonable; however, because of the level of reimbursement by
the national health insurance in France, the treatment is costly for French
hospitals.
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Langue : ANGLAIS