OBJECTIVES: Botulinum toxins A (BoNT-As) are widely used for various neurologic indications, including cervical dystonia (CD) and upper and lower limb spasticity. The objective of this analysis is to estimate the overall costs of 2 BoNT-A products—onabotulinumtoxinA (onaBoNT-A) and abobotulinumtoxinA (aboBoNT-A)—for CD in adults, and limb spasticity in adults and children (aged ≥2 years), using an economic model that evaluates a formulary conversion from onaBoNT-A to aboBoNT-A.

METHODS: A Microsoft-based model was developed to show the relative cost of botulinum toxins within an institutional (hospital system) setting. Inputs for current product use were based on relative market share of BoNT-A products, vials purchased annually by a representative institution, and the annual spend calculated with wholesale acquisition costs (WAC). Cost calculations were estimated based on therapeutic mix across approved indications, annual dosages using the maximum FDA-approved doses for each toxin, and the annual unit utilization and unit cost (WAC). Cost modeling that reflected a shift in product utilization to aboBoNT-A over 3 years was performed and annual cost estimates were compared for the aboBoNT-A indications. Total institutional spend on BoNT-A products was estimated to be $3,040,789 across all indications and $881,853 within CD and limb spasticity.

RESULTS: Transitioning 25% of the annual utilization share of onaBoNT-A to aboBoNT-A in CD and limb spasticity resulted in an estimated savings of $51,800, $64,359, and $41,314 in years 1, 2, and 3, respectively. Cumulative savings over 3 years were estimated to be $157,473.

CONCLUSIONS: In a representative institutional setting, converting onaBoNT-A use to aboBoNT-A for CD and spasticity by 25% year over year resulted in an estimated cumulative savings of $157,473 over 3 years. For the aboBoNT-A indications of CD and limb spasticity, converting from onaBoNT-A to aboBoNT-A is potentially cost saving for institutions and hospital systems.