OBJECTIVES. While BoNTA are commonly used treatments for AUL, real-world comparative data on their use are limited. ULIS-III (NCT02454803) is an international multicenter observational prospective study of patients receiving integrated upper-limb spasticity (ULS) management that includes BoNTA injections over 2 years. The objective of the present study was to compare economic outcomes of abobotulinumtoxinA(aboBoNT-A), onabotulinumtoxinA(onaBoNT-A) and incobotulinumtoxinA(incoBoNT-A) treatment, based on preliminary analysis of ULIS-III study first treatment cycle.

METHODS. The analysis compared cost outcomes of the three different BoNT-As, adjusted for relevant covariates in multivariate statistical analyses. Outcomes assessed included treatment cost per injection, treatment cost per year and cost per treatment responder (defined as achievement of the primary goal from the Goal Attainment Scaling [GAS]). Study outcomes were based on patients from all participating countries. Treatment cost included drug costs and were assessed using prices from the Italian, French and Portuguese perspective, the three largest European patient cohorts in the study.

RESULTS. The analysis included 757 adults with ULS treated with one cycle of aboBoNT-A(n=470), onaBoNT-A(n=196) or incoBoNT-A(n=91). In Italy, injection cost was €300.1, €304.5 and €352.8 for aboBoNT-A, onaBoNT-A and incoBoNT-A, respectively; in France €443.6, €485.6 and €562.7; and in Portugal €382.6, €485.6 and €562.7. Multivariate analyses confirmed that aboBoNT-A was associated with lower treatment cost than onaBoNT-A and incoBoNT-A. Average predicted yearly cost per responder for aboBoNT-A, onaBoNT-A and incoBoNT-A were €944, €1524 and €1440, respectively in Italy; €1396, €2430 and €2296 in France; and €1204, €1955 and €1918 in Portugal.

CONCLUSIONS. These real-life data indicate that treatment with aboBoNT-A may be a cost-effective BoNT-A treatment, due to lower injection cost, longer intervals between treatment, and lower cost per treatment responder. The findings were reproduced across the three countries examined to date. However, additional comparative data from larger patient cohorts would be valuable to confirm these findings.