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  4. Botulinum Toxin Utilization, Treatment Patterns, and Healthcare Costs Among Patients with Spasticity or Cervical Dystonia in the US

Botulinum Toxin Utilization, Treatment Patterns, and Healthcare Costs Among Patients with Spasticity or Cervical Dystonia in the US

Adv Ther, 2023 · DOI: https://doi.org/10.1007/s12325-023-02563-5 · Published: July 7, 2023

PharmacologyHealthcareNeurology

Simple Explanation

Spasticity is an abnormal, involuntary muscle tightness due to extended muscle contraction. This resistance in movement can be caused by stroke, multiple sclerosis, or traumatic injuries to the brain or spinal cord. Cervical dystonia is a form of sustained involuntary muscle contractions that result in abnormal or repetitive muscle movements in the neck and upper shoulders. This study was conducted to better understand BoNT-A injection patterns, use of healthcare services, and the resulting costs in patients with spasticity or cervical dystonia.

Study Duration
October 1, 2015 to December 31, 2019
Participants
2452 adults with spasticity, 1364 pediatric patients with spasticity, and 1529 adults with CD
Evidence Level
Retrospective analyses using administrative healthcare claims

Key Findings

  • 1
    These findings demonstrate significantly higher healthcare costs among patients with spasticity or cervical dystonia, and further confirm the economic burden associated with disease management.
  • 2
    AboBoNT-A was associated with the lowest injection costs for patients in each cohort, and adjusted costs from a multivariate model were 40–50% higher with incoBoNT-A and onaBoNT-A.
  • 3
    Most patients had more than one BoNT-A injection during the post-index period, and fewer than 1% of patients switched to a different toxin.

Research Summary

This study aimed to understand treatment/injection patterns of botulinum toxins type A (BoNT-As) and the characteristics, healthcare resource utilization (HCRU), and costs among patients with spasticity or CD. Overall, 2452 adults with spasticity, 1364 pediatric patients with spasticity, and 1529 adults with CD were included. Total mean all-cause healthcare costs were US$42,562 (adult spasticity), $54,167 (pediatric spasticity), and $25,318 (CD). AboBoNT-A had the lowest injection visit costs across indications. These results are suggestive of real-world resource utilization patterns and costs, and, while helpful in informing insurers’ BoNT-A management strategies, further research into cost differences is warranted.

Practical Implications

Informer for Insurers

The study results can inform insurers' BoNT-A category management strategies, enabling them to optimize resource allocation and potentially reduce healthcare costs associated with spasticity and cervical dystonia treatments.

Guidance for Treatment Choices

The finding that aboBoNT-A is associated with the lowest injection costs may guide clinicians in making more cost-effective treatment decisions when managing patients with spasticity or cervical dystonia.

Further Research Needed

Further research is warranted to understand the drivers of cost differences among different BoNT-A toxins, potentially leading to more targeted and efficient treatment strategies.

Study Limitations

  • 1
    Claims data have inherent limitations on generalizability.
  • 2
    Findings are associative and no causal inferences can be made.
  • 3
    The study only captured direct costs reported by administrative claims data.

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