Real-World Switch Rates, Treatment Patterns, and Healthcare Costs Among Patients With Spasticity Treated With Botulinum Toxins.

[INTRODUCTION] Botulinum toxin type A therapies are FDA-approved for the treatment of adult spasticity and recognized as standard of care; however, comparative real-world data on treatment patterns and costs are limited. This study aimed to compare switch rates, healthcare resource utilization (HCRU), and costs among patients with spasticity initiating onabotulinumtoxinA, abobotulinumtoxinA, or incobotulinumtoxinA.

[METHODS] Adult patients with spasticity receiving botulinum toxins between January 1, 2017, and December 31, 2023, were identified from Optum's de-identified Clinformatics Data Mart Database. Patients must have had ≥ 12 months of continuous enrollment before and after toxin initiation. Outcomes included switch rates and all-cause, spasticity-related, fall-related, fracture-related, and toxin-related healthcare resource utilization and costs.

[RESULTS] Among 1714 eligible patients, 1521 initiated onabotulinumtoxinA (88.7%), 99 initiated abobotulinumtoxinA (5.8%), and 94 initiated incobotulinumtoxinA (5.5%) as index treatment. Switch rates at 12 months post-index were lowest for onabotulinumtoxinA (1.4%) compared with abobotulinumtoxinA (4.0%), and incobotulinumtoxinA (10.6%). OnabotutlinumtoxinA initiators demonstrated lower total all-cause medical costs and fracture-related costs compared with incobotulinumtoxinA and abobotulinumtoxinA, respectively, with comparable healthcare resource utilization and other costs.

[CONCLUSION] Most patients initiated onabotulinumtoxinA with lower switch rates than those who initiated with incobotulinumtoxinA and abobotulinumtoxinA. Total costs were comparable between treatments, except for all-cause medical costs and fracture-related costs, which were lower among onabotulinumtoxinA initiators.