Pnd35 Economic Burden of Migraine in Mexico

Abstract

Objectives: Cervical dystonia (CD), pediatric lower-limb (PLL) and adult upper-limb (AUL) spasticity are disabling conditions. Treatment consists of physiotherapy and botulinum neurotoxin type A (BoNT-A) injections, in some cases, combined with an oral therapy. In the UK, healthcare resource use (RU) for these conditions is not wellreported. The objective was to characterize RU among patients responding to BoNT-A therapy versus BoNT-A non-responders. Methods: An RU questionnaire was administered to a geographically representative sample of UK physicians regularly treating CD (n=12), PLL (n=12) and AUL (n=11). Respondents had experience with different BoNT-As, broadly consistent with UK market trends. Questionnaire results were analysed; ranges of numerical responses were reported. Results: CD patients not responding to BoNTA-As were reported to have higher use of baclofen than responders: 30% (range:5% to 40%) vs. 0% (0% to 10%), with an average daily cost/person of £10.95 (£2.19 to £21.90). Use of other medications (trihexyphenidyl/benzodiazepines/gabapentin/clonazepam) were similarly elevated in BoNT-A non-responders vs. responders. Consistent patterns were reported in PLL and AUL. Use of baclofen in PLL amounted to 90% (80% to 100%) among BoNT-A non-responders vs. 50% (10% to 80%) in responders. In AUL, these estimates were 50% (5% to 100%) vs. 25% (5% to 50%), respectively. Other RU elements (including physiotherapist, specialist, pain clinic, psychologist visits) was reported as comparable among BoNT-A non-and responders. Conclusions: A notable decrease was reported in medication use in BoNT-A responders compared to non-responders. In addition to cost-savings associated with medication avoidance, the potential for adverse events associated with the use of oral medications may also be reduced. Patients who do no respond to BoNT-As can become responders by doing necessary adjustments in the dose, muscles injected, and a BoNT-A choice. An observational study is warranted to validate RU in these patient populations.