Economic evaluation of AbobotulinumtoxinA vs OnabotulinumtoxinA in real-life clinical management of cervical dystonia

Abstract

Background: Botulinum neurotoxins type A (BoNT-As) are commonly used treatments for cervical dystonia (CD). Clinical trials have demonstrated the benefits of them in these patients, but data from real-life clinical practice as well as comparative data on the cost and outcome of different BoNT-A formulations are limited. The aim of this study was to compare abobotulinumtoxinA (aboBoNT-A) and onabotulinumtoxinA (onaBoNT-A) on their clinical outcomes and drug costs in real-life clinical practice. Methods: This analysis included 356 adult patients with idiopathic CD treated with aboBoNT-A (n = 253) or onaBoNT-A (n = 103) from 38 centres across Europe and Australia (NCT00833196). The clinical outcome measures were treatment responses, changes in TWSTRS scores and changes in health utility scores from baseline to study visit 2 and 3. Health utility score was mapped from the TWSTRS total scale, using a previous publication. Costs included drug cost for France. Results: The aboBoNT-A treated group had 2.06 (95% CI: 1.15 to 3.69) times higher odds of achieving treatment response than the onaBoNT-A treated group. The adjusted mean change in TWSTRS total score from baseline to visit 3 were − 6.42 (95% CI: − 7.52 to − 5.33) for aboBoNT-A and − 3.94 (95% CI: − 5.68 to − 2.2) for onaBoNT-A, with a difference of − 2.48 (95% CI: − 4.57 to − 0.39). The corresponding difference in the adjusted mean change for health utility score was 0.008 (95% CI: 0.001 to 0.014). Mean treatment costs for aboBoNT-A and onaBoNT-A were 314.1 (95% CI: 299.1 to 329.0) and 346.6 (95% CI: 322.9 to 370.4) Euros, respectively. Conclusions: This comparative analysis indicated that treatment with aboBoNT-A may be less costly and lead to improved clinical outcomes when compared with onaBoNT-A, from a French healthcare system perspective. Additional comparative clinical data from larger patient cohorts, as well as more information about cost consequences of an improvement in clinical outcome would be of value to further confirm the findings.

Botulinum Toxin Utilization, Treatment Patterns, and Healthcare Costs Among Patients with Spasticity or Cervical Dystonia in the US

“…A 2015 study, noting the effectiveness of BoNT-As for patients with CD, concluded that cost-effectiveness studies for these patients in the US were limited and that additional research was needed [ 26 ]. A 2020 article comparing cost-effectiveness of aboBoNT-A and onaBoNT-A in 356 adult patients with CD in Europe and Australia indicated that treatment with aboBoNT-A may be less costly and lead to improved clinical outcomes when compared with onaBoNT-A [ 27 ].…”

Botulinum Toxin: From Poison to Possible Treatment for Spasticity in Spinal Cord Injury

“…There is a study that suggests that the treatment for cervical dystonia with ABO may be less costly and lead to improved clinical outcomes when compared with ONA. There is another study that suggests that ABO may have more intense and lasting effects, but in all cases, the results are relativized because the calculations are made on the doses recommended by the FDA for each pathology and according to each formulation, which are, therefore, not comparable [ 27 , 28 ].…”

Experiences on the administration of botulinum toxin in movement disorders

“…This causes repetitive rotating motion of the head, neck, and shoulder, as well as painful and disabling abnormal posture. [7,8] Another group of patients into whom we injected BoNT is chronic migraine patients. It is considered that nociceptive fibers inhibit peripheral sensitization and reduce central sensitization, except local muscle paralysis caused by BoNT in chronic migraine.…”