Objective: To compare health care resource utilization (HCRU) and costs among patients with cervical dystonia (CD) in the US who are persistent vs nonpersistent with onabotulinumtoxinA (onabotA) treatment.

Background: There is a lack of real-world evidence data on botulinum neurotoxin (BoNT) persistence, HCRU, and costs among patients with CD.

Method: This longitudinal cohort study used IBM MarketScan^® Commercial and Medicare Supplemental Databases administrative claims data. Patients were identified with a first medical claim for onabotA and CD diagnosis between 1/1/2011 and 2/28/2019. A patient was considered nonpersistent if they had a treatment gap (>30 days) or switched to another BoNT. Anatomical localization (guidance) techniques, HCRU, and cost were assessed at 12 months between persistent and nonpersistent patients.

Results: 4136 onabotA-treated patients with CD were identified (mean age 54 yrs, 73% female). OnabotA users receiving electromyography during initial injection were more likely to be treatment persistent at 12 months than those receiving ultrasound or no guidance technique [table2]. At 12 months, no significant differences were noted between onabotA-persistent (18%) and nonpersistent (82%) patients regarding age, sex, payor, and baseline comorbidities [table1][table2]. However, persistent patients had lower opioid use than nonpersistent patients [50.8% vs 59.5%; P<0.001) [table2]. 28% of patients who were nonpersistent due to a >30-day gap between onabotA doses restarted treatment during the study. OnabotA-persistent vs nonpersistent patients had similar overall all-cause total visits and total costs [table3], and similar all-cause and CD-related prescription fills, although prescription costs were slightly higher in the persistent group [table3]. Persistent patients had fewer all-cause inpatient visits and lower inpatient costs, but more CD-related outpatient visits and higher associated costs than nonpersistent patients [table3].

Conclusion: OnabotA persistence vs nonpersistence was associated with more CD-related outpatient visits and costs, but fewer all-cause inpatient visits and costs, similar all-cause prescription fills and costs, and similar all-cause visits and costs. More than a quarter of nonpersistent patients returned to treatment during the study.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/persistence-health-care-resource-utilization-and-costs-among-onabotulinumtoxina-treated-patients-with-cervical-dystonia-in-the-us/