(Research Hub Theater) Persistence, Health Care Resource Utilization, and Costs Among OnabotulinumtoxinA-treated Patients with Cervical Dystonia in the US

Background and/or Objectives: 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.

Design: This longitudinal cohort study used IBM MarketScan® Commercial and Medicare Supplemental Databases administrative claims data.

Setting: US sites

Participants: Patients with a first medical claim for onabotA and CD diagnosis during 1/1/2011–2/28/2019.

Interventions: OnabotA

Main Outcome Measures: Anatomical localization (guidance) techniques, HCRU, and cost were assessed at 12 months between persistent and nonpersistent patients. A patient was considered nonpersistent if they had a treatment gap (>30 days) or switched to another botulinum neurotoxin (BoNT).

Results: 4136 onabotA-treated CD patients 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. At 12 months, no significant differences were noted between onabotA-persistent (18%) and nonpersistent (82%) patients regarding age, sex, payor, and baseline comorbidities. However, persistent patients had lower opioid use than nonpersistent patients [50.8% vs 59.5%; P< 0.001). 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 all-cause total visits and total costs, and similar all-cause and CD-related prescription fills, although prescription costs were slightly higher in the persistent group. 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.

Conclusions: 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.