Cost effectiveness and impact on quality of life of abobotulinumtoxinA and onabotulinumtoxinA in the treatment of children with lower limb spasticity in Canada

Abstract

Background: Injectable botulinum neurotoxins are a mainstay of treatment for pediatric spasticity. AbobotulinumtoxinA and onabotulinumtoxinA are both injectable toxin therapies used to treat pediatric lower limb (PLL) spasticity in Canada. The objective of this study was to assess the cost-effectiveness of abobotulinumtoxinA vs. onabotulinumtoxinA in the treatment of PLL spasticity in Canada. Methods: A probabilistic Markov cohort model with a 2-year time horizon was developed, with health states defined by response to therapy, as characterized by the goal attainment scale (GAS). Based on randomized controlled trial evidence, response to therapy was similar or higher for abobotulinumtoxinA relative to onabotulinumtoxinA; uncertainty was incorporated into model parameters, however, as the two therapies have not been compared head-to-head. Canadian resource use and cost data were incorporated. Results: In the base case, abobotulinumtoxinA generated 1.48 quality-adjusted life years over the model time horizon, compared to 1.47 for onabotulinumtoxinA. AbobotulinumtoxinA was associated with cost savings of $123 CAD, reflecting lower costs in both medication acquisition and health services. The estimated improvement to quality of life and reduced costs result in an estimate of economic dominance for abobotulinumtoxinA over onabotulinumtoxinA. This dominant result persisted across probabilistic and scenario analyses. KEY POINTS FOR DECISION MAKERSBased on a review of available clinical evidence, abobotulinumtoxinA was found to have significant and/or numerical efficacy benefits to onabotulinumtoxinA on functional outcomes (Goal Attainment Scale) and tone (Modified Ashworth Scale) and in the treatment of pediatric lower limb spasticity In this cost-effectiveness analysis, abobotulinumtoxinA was found to be associated with greater quality-adjusted life years and lower costs than onabotulinumtoxinA (economically dominant) A limitation of this analysis was the uncertainty around key parameters. Specifically, the lack of head-to-head comparison data for the two therapies, and variable data regarding likely onabotulinumtoxinA dosing in PLL in clinical practice. However, across a range of plausible scenarios, the economic dominant result remained.

Comparative efficacy, safety, and cost-effectiveness of abobotulinumtoxinA and onabotulinumtoxinA in children with upper limb spasticity: a systematic literature review, indirect treatment comparison, and economic evaluation

“…The presented clinical and economic findings are in line with earlier analyses. One published NMA 23 and one published cost-effectiveness analysis 24 compared the efficacy and costeffectiveness of BoNT-A therapies for the treatment of children with spasticity in the lower limbs, though this study is the first to evaluate children with spasticity in the upper limbs and from a UK NHS perspective. The previous NMA found that aboBoNT-A (15U/kg and 10U/kg in each leg) was more efficacious than onaBoNT-A (4U/kg per leg, 4U/kg per leg+casting, 4U/kg, and 8U/kg) in terms of MAS at 12-weeks in children with lower limb spasticity.…”

“…21 The previous cost-effectiveness analysis found that aboBoNT-A was dominant compared with onaBoNT-A for the treatment of children with spasticity in the lower limbs in Canada. 24 A retrospective chart review of adults and children in the USA found that substituting onaBoNT-A with aboBoNT-A for the treatment of limb spasticity and cervical dystonia would result in a cost savings of $259, 131 (2017/18 US dollars) across a fivehospital healthcare system. 70 This is also consistent with findings by independent authors based on claims analyses.…”

“…The results of this evidence synthesis and economic analysis are found that aboBoNT-A had a higher treatment response rate resulting in greater quality of life and lower annual costs compared with onaBoNT-A. 23,24 Studies such as these can be used to inform clinical pathways and reimbursement decisions.…”

“…Previous analyses have evaluated the effectiveness and costs of BoNT-A products for the treatment of spasticity in adults [20][21][22] and the lower limbs of children. 23,24 However, these methods have not been used to compare treatments for pediatric ULS. The objective A c c e p t e d M a n u s c r i p t of this study was to evaluate the clinical efficacy, safety, and cost-effectiveness of alternative BoNT-A products for managing children with ULS.…”