Victoria K Karschney1, David R Greeley2. 1. Medical Student, University of Washington, Spokane, WA. 2. Founding Neurologist, Northwest Neurological, Spokane, WA.
Abstract
BACKGROUND: Botulinum neurotoxin type A (BoNT-A) is an effective treatment for many chronic conditions, but the economic implications of repeated treatments can be a burden on patients. The 3 commercial preparations of BoNT-A types available today are onabotulinumtoxinA, abobotulinumtoxinA, and incobotulinumtoxinA, but no clear differences have been found in clinical efficacy between these 3 type A toxins in blinded comparative studies. OBJECTIVE: To conduct a cost-minimization analysis in a cohort of patients with chronic neurologic conditions who switched treatment from onabotulinumtoxinA to incobotulinumtoxinA. METHODS: The study was a single-center, retrospective review of data from a large, private, neurological practice in Spokane, WA. A comprehensive patient chart review was conducted of all patients who were switched from established onabotulinumtoxinA therapy to incobotulinumtoxinA therapy between 2012 and 2019. The patients were switched at a 1:1-unit ratio. All patients had commercial insurance or Medicare coverage. Dosage, injection intervals, wastage, treatment costs, switchback data, and patient savings program eligibility were evaluated for the period of 1 year before and 1 year after the switch from onabotulinumtoxinA to incobotulinumtoxinA therapy. RESULTS: The most frequently treated indication was cervical dystonia (N = 61; 54.5%), followed by chronic migraine (N = 36; 32.1%). After switching to incobotulinumtoxinA therapy, botulinum toxin wastage was reduced by 87.3% (from 150.9 units to 19.1 units), and the cost was reduced by 32.2% (from $5108 to $3461) per patient annually. A total of 14,635 units in unavoidable wastage and $182,792 in annual botulinum toxin costs were saved as a result of the switch in therapy. Patients remained at consistent dosing intervals after switching to incobotulinumtoxinA therapy. A total of 8 patients switched back to onabotulinumtoxinA treatment during this review, including 3 patients who switched back because of insurance reasons, and 5 who had self-reported efficacy concerns. The 70 commercially insured patients in the study who were eligible for the patient savings program for each of the 2 therapies saved an average of $2076 (241.5%) in annual costs after switching from onabotulinumtoxinA to incobotulinumtoxinA. CONCLUSION: Our findings showed that switching from onabotulinumtoxinA to incobotulinumtoxinA at similar intervals and dosages achieved considerable cost-savings, with a low incidence of switching back.
BACKGROUND: Botulinum neurotoxin type A (BoNT-A) is an effective treatment for many chronic conditions, but the economic implications of repeated treatments can be a burden on patients. The 3 commercial preparations of BoNT-A types available today are onabotulinumtoxinA, abobotulinumtoxinA, and incobotulinumtoxinA, but no clear differences have been found in clinical efficacy between these 3 type A toxins in blinded comparative studies. OBJECTIVE: To conduct a cost-minimization analysis in a cohort of patients with chronic neurologic conditions who switched treatment from onabotulinumtoxinA to incobotulinumtoxinA. METHODS: The study was a single-center, retrospective review of data from a large, private, neurological practice in Spokane, WA. A comprehensive patient chart review was conducted of all patients who were switched from established onabotulinumtoxinA therapy to incobotulinumtoxinA therapy between 2012 and 2019. The patients were switched at a 1:1-unit ratio. All patients had commercial insurance or Medicare coverage. Dosage, injection intervals, wastage, treatment costs, switchback data, and patient savings program eligibility were evaluated for the period of 1 year before and 1 year after the switch from onabotulinumtoxinA to incobotulinumtoxinA therapy. RESULTS: The most frequently treated indication was cervical dystonia (N = 61; 54.5%), followed by chronic migraine (N = 36; 32.1%). After switching to incobotulinumtoxinA therapy, botulinum toxin wastage was reduced by 87.3% (from 150.9 units to 19.1 units), and the cost was reduced by 32.2% (from $5108 to $3461) per patient annually. A total of 14,635 units in unavoidable wastage and $182,792 in annual botulinum toxin costs were saved as a result of the switch in therapy. Patients remained at consistent dosing intervals after switching to incobotulinumtoxinA therapy. A total of 8 patients switched back to onabotulinumtoxinA treatment during this review, including 3 patients who switched back because of insurance reasons, and 5 who had self-reported efficacy concerns. The 70 commercially insured patients in the study who were eligible for the patient savings program for each of the 2 therapies saved an average of $2076 (241.5%) in annual costs after switching from onabotulinumtoxinA to incobotulinumtoxinA. CONCLUSION: Our findings showed that switching from onabotulinumtoxinA to incobotulinumtoxinA at similar intervals and dosages achieved considerable cost-savings, with a low incidence of switching back.
Authors: Joseph L Dieleman; Ellen Squires; Anthony L Bui; Madeline Campbell; Abigail Chapin; Hannah Hamavid; Cody Horst; Zhiyin Li; Taylor Matyasz; Alex Reynolds; Nafis Sadat; Matthew T Schneider; Christopher J L Murray Journal: JAMA Date: 2017-11-07 Impact factor: 56.272