Highlights
- •This cost analysis focused on physician prescribing practices rather than the drugs themselves.
- •Physicians using botulinum toxin predominantly for spasticity were included.
- •A majority of physicians exclusively used the costliest drug, onabotulinumtoxinA.
- •Those prescribing abobotulinumtoxinA or incobotulinumtoxinA had lower cost per patient.
- •Doses and injections per year were not significantly different between groups.
Abstract
Objective
To estimate differences in botulinum toxin type A (BoNT-A) treatment costs per patient
for spasticity-injecting physicians, with a focus on physicians’ use of alternative
BoNT-A agents other than onabotulinumtoxinA.
Design
Retrospective cohort study.
Setting
National Medicare data for fee-for-service beneficiaries in 2017.
Participants
A total of 116 physicians, 6829 BoNT-A procedures, and 3051 patients were included
in this analysis. Most physicians were physiatrists (84%) and used only onabotulinumtoxinA
(82%).
Interventions
Type of BoNT-A selected by physicians was the independent variable of interest. Included
physicians were separated into 2 groups: (1) onabotulinumtoxinA only injectors and
(2) abobotulinumtoxinA and/or incobotulinumtoxinA injectors (may still use onabotulinumtoxinA).
Main Outcome Measure
Average cost per patient per year.
Results
The total average BoNT-A cost per patient per year was significantly less for physicians
who used abobotulinumtoxinA and/or incobotulinumtoxinA vs those who used only onabotulinumtoxinA
($3684 vs $4739; P=.01). Patients’ average annual out-of-pocket costs also reflected a similar difference
($855 vs $1082; P=.02) between the groups. Doses used and numbers of injections per patient per year
were not significantly different between groups.
Conclusions
The present analysis demonstrated lower cost per patient for both the payer and patient
when physicians used types of BoNT-A other than onabotulinumtoxinA for spasticity.
Nevertheless, most physicians in this spasticity-focused study used exclusively onabotulinumtoxinA,
the most expensive BoNT-A available. Reasons for this are complex and include history
on the market and approved indications beyond those associated with spasticity. However,
future research should continue to identify such issues with a goal of finding solutions
to improve cost inefficiencies.
Keywords
List of abbreviations:
BoNT-A (Botulinum toxin type A), CMS (Centers for Medicare & Medicaid Services), CPT (current procedural terminology), OOP (out of pocket)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: November 28, 2021
Accepted:
October 28,
2021
Received in revised form:
October 22,
2021
Received:
May 12,
2021
Footnotes
Disclosures: R Kazerooni was an employee of Merz Pharmaceuticals, LLC at the time of this analysis. M Verduzco-Gutierrez participated on speaker's bureaus and advisory boards for Merz, Allergan, Ipsen, and Medtronic. The other authors have nothing to disclose.
Identification
Copyright
© 2021 by the American Congress of Rehabilitation Medicine.
