OBJECTIVES: Treatment with botulinum neurotoxin type A (BoNT-A) can lead to clinical and treatment-goal improvement in adults and children for a variety of indications related to spasticity, including adults with upper limb spasticity (AUL). There are implications for health care resource utilization (HCRU) and costs, and patient outcomes, due to differences across individual BoNT-A therapies with respect to acquisition cost, response rates, and dosing. The objective of this study was to compare cost per response obtained with abobotulinumtoxinA (aboBoNT-A) and onabotulinumtoxinA (onaBoNT-A) for AUL in Canada.

METHODS: The cost-consequence model utilized here incorporated data describing response rates in AUL by BoNT-A therapy, health care resource utilization and costs by response status, and acquisition cost of BoNT-As in Canada. Response rates and were characterized by the Goal Attainment Scale and estimated via the ULIS-III prospective observational study (75.2% aboBoNT-A vs. 60.2% onaBoNT-A). Dose and dosing interval were also taken from the ULIS-III study, and found less frequent dosing for aboBoNT-A (31.8 weeks vs. 29.1 for onaBoNT-A). A physician survey initially conducted in the United Kingdom and validated by Canadian physicians through qualitative interviews was used to estimate HCRU by response status. Probabilistic and one-way sensitivity analyses were conducted.

RESULTS: AboBoNT-A resulted in a higher proportion of responders as well as lower annual costs per patient for AUL management (savings of $117) compared with onaBoNT-A. Differences in injection intervals and a higher treatment response rate for people receiving aboBoNT-A compared with onaBoNT-A contributed to results, in addition to a lower acquisition cost for aboBoNT-A. Total cost per responder was lower for patients receiving aboBoNT-A compared with onaBoNT-A ($10,239 vs $13,037). Results were consistent across sensitivity analyses.

CONCLUSIONS: With higher response rates and reduced costs, aboBoNT-A may be an efficient choice for treating AUL in Canada.