OBJECTIVES : Cervical dystonia (CD), pediatric lower-limb (PLL) and adult upper-limb (AUL) spasticity are disabling conditions. Treatment consists of physiotherapy and botulinum neurotoxin type A (BoNT-A) injections, in some cases, combined with an oral therapy. In the UK, healthcare resource use (RU) for these conditions is not well-reported. The objective was to characterize RU among patients responding to BoNT-A therapy versus BoNT-A non-responders.

METHODS : An RU questionnaire was administered to a geographically representative sample of UK physicians regularly treating CD (n=12), PLL (n=12) and AUL (n=11). Respondents had experience with different BoNT-As, broadly consistent with UK market trends. Questionnaire results were analysed; ranges of numerical responses were reported.

RESULTS : CD patients not responding to BoNTA-As were reported to have higher use of baclofen than responders: 30% (range:5% to 40%) vs. 0% (0% to 10%), with an average daily cost/person of £10.95 (£2.19 to £21.90). Use of other medications (trihexyphenidyl/benzodiazepines/gabapentin/clonazepam) were similarly elevated in BoNT-A non-responders vs. responders. Consistent patterns were reported in PLL and AUL. Use of baclofen in PLL amounted to 90% (80% to 100%) among BoNT-A non-responders vs. 50% (10% to 80%) in responders. In AUL, these estimates were 50% (5% to 100%) vs. 25% (5% to 50%), respectively. Other RU elements (including physiotherapist, specialist, pain clinic, psychologist visits) was reported as comparable among BoNT-A non- and responders.

CONCLUSIONS : A notable decrease was reported in medication use in BoNT-A responders compared to non-responders. In addition to cost-savings associated with medication avoidance, the potential for adverse events associated with the use of oral medications may also be reduced. Patients who do no respond to BoNT-As can become responders by doing necessary adjustments in the dose, muscles injected, and a BoNT-A choice. An observational study is warranted to validate RU in these patient populations.