Costs of Treating Dystonias and Hemifacial Spasm with Botulinum Toxin A

Abstract

Botulinum toxin (BTX) has become a safe and effective therapeutic tool in the treatment of a variety of neurological disorders, especially dystonias. One major disadvantage, however, is the high cost of a single injection of BTX. In this study of 835 patients, we calculated the cost of treatment with BTX serotype A (BTX-A) for different dystonias and hemifacial spasm. The annual expenditure per patient for BTX-A injections in this cohort totalled (mean +/- standard deviation) 1030 Deutschmarks (DM) [1996 values] +/- DM610 [$US570 +/- $US340; 230 +/- 130 pounds sterling (Pound)] for blepharospasm (n = 158), DM1450 +/- DM1520 ($US800 +/- $US830; 310 Pounds +/- 280 Pounds) for craniocervical dystonia (n = 148), and DM1480 +/- DM780 ($US810 +/- $US430; 330 Pounds +/- 180 Pounds) for oromandibular dystonia (n = 16), while the treatment of cervical dystonia consumed DM4590 +/- DM2060 ($US2520 +/- $US1130; 960 Pounds +/- 420 Pounds) [n = 362] per patient. In order to alleviate symptoms in patients with hemifacial spasm (n = 151), DM510 +/- DM270 ($US280 +/- $US150; 110 Pounds +/- 60 Pounds) had to be spent annually. The expenses for surgical therapy for cervical dystonia were DM10,120 +/- DM1900 (n = 54). No major differences concerning expenditure could be found in this study between the 2 available preparations of BTX. However, there appeared to be a lower rate of adverse effects with the Botox formulation, compared with the Dysport formulation, of BTX-A (this difference was statistically significant, i.e. p < 0.001). Although the cost of an individual injection is high, other cost factors also substantially contribute to the societal costs of adult-onset dystonias. Some of these costs may be attenuated with the use of BTX. The subjective and objective relief of these socially devastating and sometimes painful conditions rewards the expenditure associated with the use of BTX-A.

Botulinum neurotoxin — from laboratory to bedside

“…Specifically, it was found that the therapeutic indexes of the botulinum toxin type A and B preparations were ordered according to the molecular weights (MW) of the botulinum neurotoxin complexes: the preparation containing the highest MW complex (BOTOX ® ) had a higher therapeutic index (i.e., less systemic diffusion) than the preparation containing the intermediate MW complex mixture (Dysport ® ), which was higher than the lowest MW preparation (Neurobloc ® ) (Aoki, 2001;. These preclinical results are consistent with clinical findings of lower adverse event rates with the 900 kD complex preparation (BOTOX ® ) than with the mixed, of 900 kD and 500-600 kD, complex preparation (Dysport ® ) (Dodel et al, 1997; reviewed in Sampaio et al, 2004). They are also consistent with the recent report of a statistically significant increase in the frequency of blurred vision with Dysport ® over placebo in the treatment of cervical dystonia (Truong et al, 2005).…”

Service-Based Survey of Dystonia in Munich

“…Therefore, due to these favourable referral and treatment patterns, we could provide reliable data from patients treated with botulinum toxin. The results presented here may have implications regarding botulinum toxin clinic service provision [2].…”

“…The advent of an effective treatment by weakening dystonic muscles with localised injections of botulinum toxin increased clinical interest in the disease and hence recognition. Due to the high costs associated with this therapy, dystonia has become a disease with economic implications in terms of public health [2]. Therefore, epidemiological data can provide important information for cost analysis as well as for the planning of appropriate patient care.…”

Pharmacological differences and clinical implications of various botulinum toxin preparations: a critical appraisal

“…A more recent study that used DAbS to compare the ED 50 of different BoNTAs showed that a DAbS of 2 could be obtained with 6 U of onabotulinumtoxinA and 10 U of incobotulinumtoxinA (Brown et al, 2013). Overall, onabotulinumtoxinA showed greater efficacy and longer effect duration than incobotulinumtoxinA at both high and low dosages in the DAbS model (Brown et al, 2013 (Marion et al, 1995) 1: 3 NA (Nussgens and Roggenkamper, 1997;Roggenkamper et al, 2006) 1: 4 AbobA>OnabA (Sampaio et al, 1997) 1: 4 AbobA>OnabA (Bihari, 2005) 1: 4 -1: 5 NA (Bentivoglio et al, 2012) 1: 1 -1: 13.3 NA (Dodel et al, 1997) 1:4 -1:6 AbobA>OnabA Cervical dystonia (Naumann et al, 2003) 1: 5 -1: 6 AbobA=OnabA (Odergren et al, 1998) 1: 3 AbobA=OnabA (Ranoux et al, 2002) 1: 3 -1: 4 AbobA>OnabA (Bihari, 2005) 1: 4 -1: 5 NA (Misra et al, 2012) 3.1: 1 AbobA>OnabA (Rystedt et al 2015) 1.7: 1 NA (Yun et al 2015) 2.5: 1 AbobA=OnabA (Dodel et al, 1997) 1:4 -1:6 AbobA>OnabA (Van den Bergh and Lison, 1998) 1: 2.5 AbobA=OnabA Hemifacial spasm (Marion et al, 1995) 1: 3 NA (Bihari, 2005) 1: 4 -1: 5 NA (Dodel et al, 1997) 1:4 -1:6 AbobA>OnabA (Van den Bergh and Lison, 1998) 1: 2.5 AbobA=OnabA Spasticity (Rasmussen, 2000) 1: 4 NA (Bhakta et al, 1996) 1: 4 -1: 5 NA (Hesse et al, 2012) 1: 5 NA ( Keren-Capelovitch, et al 2010) 1: 2.5 NA Abbreviations: OnabA =OnabotulinumtoxinA; AbobA=AbobotulinumtoxinA; NA=not available/not applicable © C I C E d i z i o n i I n t e r n a z i o n a l i at least 12 months, were administered increasing doses of onabotulinumtoxinA until a similar response to that obtained with abobotulinumtoxinA was observed. The dose ratio between onabotulinumtoxinA and abobotulinumtoxinA was 1:3 (Marion et al, 1995).…”