PND18 BoNT-As for Adult Spasticity and Cervical Dystonia: Cost-Effectiveness Analysis and the Cost of Response in the United Kingdom

Abstract

For adults with spasticity or cervical dystonia (CD), treatment with botulinum neurotoxin type A (BoNT-A) has been shown to improve achievement of treatment goals. Considering the costs of available BoNT-A therapies could increase the efficiency of healthcare spending. The objective of this analysis was to evaluate the average expenditures per response obtained with abobotulinumtoxinA (aboBoNT-A) and onabotulinumtoxinA (onaBoNT-A) for spasticity and CD. Cost-effectiveness analyses were conducted to compare aboBoNT-A and onaBoNT-A for treatment of upper limb spasticity (ULS), lower limb spasticity (LLS), and CD, in the United Kingdom. Effectiveness was defined as response to therapy. Response rates and dosing were based on observational studies for ULS and CD. For LLS, real-world observational data were not available, so response rates were based on systematic literature reviews with meta-analysis of clinical trials and dosing based on UK product labels. BoNT-A treatment intervals were based on real-world data when available (ULS), or otherwise were assumed to follow similar patterns to those observed in clinical trials (LLS and CD). Resource use for responders and non-responders was based on a UK physician survey. Unit costs were informed by UK fee schedules. Compared with onaBoNT-A, aboBoNT-A resulted in lower annual costs per patient for the management of ULS, LLS, and CD (savings of £302, £584, and £422, respectively). Results were driven by differences in injection intervals and a higher treatment response rate for people receiving aboBoNT-A compared with onaBoNT-A. Total cost per responder was lower for patients receiving aboBoNT-A compared with onaBoNT-A (ULS: £43,266 vs £55,416; LLS: £98,962 vs £209,376; CD: £13,883 vs £21,817). Results were robust to sensitivity analyses. With high response rates and low costs, aboBoNT-A may be an efficient choice for treating adult spasticity and cervical dystonia in the UK.