OBJECTIVES: Assess economic costs associated with botulinum toxin-A (BoNT-A) treatment of adult patients with upper limb (AUL) spasticity in a real-life setting in France.

METHODS: Pharmaco-economic analysis comparing annual treatment costs of AUL spasticity with different BoNT-As: abobotulinumtoxinA (aboBoNT-A), onabotulinumtoxinA (onaBoNT-A) and incobotulinumtoxinA (incoBoNT-A).

Analysis considered BoNT-A unit costs, injection intervals, and dosing data. Unit costs were estimated from retail prices (2018), without commercial offer. Average BoNT-A injection interval was estimated from published real-world evidence (ULIS-III study). Doses of BoNT-As of interest were estimated as real-life average administered doses based on practice-specific market research. BoNT-A products have non-interchangeable potency units.

RESULTS: Real-life average administered doses per injection were: aboBoNT-A=463U (95% CI 413, 513), onaBoNT-A=223U (95% CI 195, 251), and incoBoNT-A=207U (95% CI 178, 236).

Applying estimated unit costs, cost per injection was: aboBoNT-A=€259.2, onaBoNT-A and incoBoNT-A =€529.6. Accounting for BoNT-A injections intervals (22, 19 and 17 weeks for aboBoNT-A, onaBoNT-A and incoBoNT-A, respectively (Turner-Stokes et al. 2017)), overall annual injection cost per patient was: aboBoNT-A=€614.0, onaBoNT-A=€1,453.5, and incoBoNT-A=€1,624.5.

The estimated annual treatment costs with aboBoNT-A was therefore 2.4 times lower than with onaBoNT-A and 2.6 times lower than incoBoNT-A in the average administered doses scenario.

CONCLUSIONS: Considering administered doses, treating AUL spasticity with aboBoNT-A appears cost-saving in comparison to alternative treatment options (onaBoNT-A/incoBoNT-A). This can be explained by both aboBoNT-A unit costs and a long duration of response (Gracies 2018), associated with less frequent reinjections.

References

Lynne Turner-Stokes, Stephen Ashford, Jorge Jacinto, Klemens Fheodoroff, Gustavo Suarez, Pascal Maisonobe. Time to retreatment with botulinum toxin A in upper limb spasticity management: initial data from the Upper Limb International Spasticity (ULIS)-III study. Poster presented at MDS 2017

Gracies JM et al. Effects Of Repeated AbobotulinumtoxinA Injections In Upper Limb Spasticity Muscle Nerve 57: 245–254, 2018.