Objective: To evaluate the cost-effectiveness of Botulinum Toxin A in our movement disorder division.

Background: Botulinum Toxin A is an FDA-approved treatment for various medical conditions, including neurological disorders. It is an expensive drug and its wastage is an under-recognized healthcare burden. In 2021, Medicare Part B and D spent over $430 million on Onabotulinumtoxin A alone, with a documented wastage of 8.65%, resulting in over $37 million wasted.

Method: We performed a retrospective chart review of Botulinum Toxin A usage from February to April 2023 in our movement disorder division.

Results: Four movement disorder specialists performed chemodenervation in 232 patients, with 68% being female and 39% having a diagnosis of cervical dystonia. A total of 50,700 units were ordered, and 6,837 units (13.5%) were wasted, resulting in $41,842 in 3 months and an estimated $167,369 wastage in 12 months. The average wastage in Hemifacial spasms, blepharospasms, and migraines was 60, 50, and 47 units, respectively. In 74 patients, 50 units or more were wasted.

Conclusion: The unavailability of smaller unit vials and single-patient use policy are two main factors responsible for the wastage. A simple switch to 50u vials would have reduced the waste by more than 50% in our case. Hence, simple cost-effective measures can save a lot of taxpayer money.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/botulinum-toxin-a-usage-in-movement-disorder-division-a-retrospective-chart-review/