OBJECTIVES: Botulinum toxins A (BoNT-As), including abobotulinumtoxinA (aboBoNT-A), onabotulinumtoxinA (onaBoNT-A), and incobotulinumtoxinA (incoBoNT-A), represent first-line treatments for adult and pediatric patients with spasticity (SP) or cervical dystonia (CD). Evidence on real-world utilization and costs is limited. The objective was to describe BoNT-A treatment/injection patterns and healthcare costs among these patients.

METHODS: Analyses were conducted using administrative healthcare claims from the IQVIA PharMetrics^® Plus database of commercially or self-insured members. The study period was from October 1, 2015, to December 31, 2019. Patients were selected based on HCPCS J-codes for BoNT-A (index date) and ICD-10 diagnosis codes for SP and SP etiology or CD with 6 months of continuous enrollment with medical and pharmacy benefits before the index date (pre-index) and 12 months starting on the index date (post-index). Pharmacy, outpatient, and inpatient costs were included in all-cause cost analyses (USD). Injection-related costs accounted for guidance techniques and anesthesia.

RESULTS: Among 3-million insured members and of 5,345 eligible patients, 2,452 adult and 1,364 pediatric patients with SP and 1,529 patients with CD were included in the cohort. Demographic and clinical characteristics were representative of typical profiles for these conditions. Median all-cause healthcare costs were $21,480 and $28,467 in adult and pediatric SP, respectively, and $15,030 in CD. In adult SP, the median total cost of BoNT-A injection visits was $1,902 with aboBoNT-A, $2,374 with onaBoNT-A and $2,203 with incoBoNT-A. In pediatric SP, median costs were $2,308, $3,148, and $2,357, respectively. In CD, costs were $1,505, $1,948, and $1,660, respectively.

CONCLUSIONS: AboBoNT-A was associated with the lowest injection visit costs across indications. These results are suggestive of real-world resource utilization patterns and costs and can help inform insurers’ BoNT-A category management strategies.