Cost Efficiency Analysis for Spasticity Management Based on Physician Botulinum Toxin Prescribing Habits

Objective To estimate differences in botulinum toxin type A (BoNT-A) treatment costs per patient for spasticity-injecting physicians, with a focus on physicians’ use of alternative BoNT-A agents other than onabotulinumtoxinA. Design Retrospective Cohort Study Setting 2017 National Medicare data for fee for service beneficiaries Participants Physicians who use BoNT-A treatments predominantly for spasticity chemodenervation, along with their patients Interventions Type of BoNT-A selected by physicians was the independent variable of interest. Included physicians were separated into two groups: (1) onabotulinumtoxinA only injectors; and (2) abobotulinumtoxinA and/or incobotulinumtoxinA injectors (may still utilize onabotulinumtoxinA). Main Outcome Measure Average cost per patient per year Results A total of 116 physicians, 6,829 BoNT-A procedures, and 3,051 patients were included in this analysis. Most physicians were physiatrists (84%) and utilized onabotulinumtoxinA only (82%). Total average BoNT-A cost per patient per year was significantly less for physicians who utilized abobotulinumtoxinA and/or incobotulinumtoxinA versus onabotulinumtoxinA-only physicians ($3,684 vs $4,739; p=0.01). Patients’ average annual out-of-pocket costs also reflected a similar difference ($855 vs $1,082; p=0.02) between the groups. Doses utilized and numbers of injections per patient per year were not significantly different between groups. Conclusions The present analysis demonstrated lower cost per patient for both the payer and patient when physicians utilized types of BoNT-A other than onabotulinumtoxinA for spasticity. Nevertheless, most physicians in this spasticity-focused study utilized exclusively onabotulinumtoxinA, the most expensive BoNT-A available. Reasons for this are complex and include history on the market and approved indications beyond those associated with spasticity; however, future research should continue to identify such issues with a goal of finding solutions to improve cost inefficiencies.