Real-World Treatment Switch Rates, and Healthcare Costs of Botulinum Toxin Type A Among Patients with Cervical Dystonia in the USA: A Retrospective Claims Analysis

Real-world evidence on comparative treatment patterns and cost is limited for botulinum toxin type A (BoNTA) treatments for cervical dystonia (CD). This study aims to evaluate treatment switch rates, healthcare resource utilization (HCRU), and healthcare costs among patients with cervical dystonia initiating BoNTAs in the USA. This retrospective study analyzed real-world data from Optum’s de-identified Clinformatics® Data Mart Database between January 1, 2016 and December 31, 2024. Eligible adults with CD with ≥ 12-month continuous enrollment before and after the first BoNTA treatment were included. The first date of BoNTA administration after the first CD identification in the study period was assigned as the index date. Treatment switch rates were assessed during the first 12 months following BoNTA initiation and at anytime before the study period end. Annual healthcare resource use and healthcare costs were also assessed in the 12 months following treatment initiation. Overall, 1756 adults with CD initiated therapy on BoNTAs. OnabotulinumtoxinA (onabotA) (88.6%; 1555/1756) was utilized most, followed by incobotulinumtoxinA (incobotA) (9.3%; 163/1756), and abobotulinumtoxinA (2.2%; 38/1756). As a result of the small sample size of abobotulinumtoxinA, comparative analysis was focused on onabotA and incobotA. Treatment switch was comparable between onabotA and incobotA during 12-month follow-up. Treatment switch at anytime before study period end was lower for onabotA versus incobotA initiators (2.6% vs. 6.8%; P = 0.007). Annual HCRU and costs were comparable between onabotA and incobotA, except CD-related costs and toxin-related costs were lower for onabotA. Patients with CD who initiated therapy on onabotA had comparable switch rates at 12 months but were less likely to switch to another BoNTA at anytime and had lower or comparable costs to incobotA. Cervical dystonia (CD) is a condition of sustained involuntary muscle contractions that result in abnormal or repetitive muscle movements in the neck and upper shoulders. These movements can be painful and may be associated with a significant decrease in quality of life, work productivity, and cause severe economic burden. Many studies have shown that botulinum toxin type A (BoNTA) treatments are safe and effective in reducing muscle tightness and improving the normal range of motion. It is therefore important to understand the treatment switch rates, and healthcare costs of BoNTA among patients with CD in the USA for the proper management of this disease. This study was conducted to better understand real-world BoNTA treatment patterns, use of healthcare services, and the resulting costs in patients with CD.