Healthcare resource utilization and costs among patients with post-stroke spasticity before and after spasticity management including onabotulinumtoxina.
Alberto Esquenazi, Lisa Bloudek, Kristen Migliaccio-Walle and 4 others
PMID 37902443WHAT IT FOUND
In 735 adults with post-stroke spasticity, healthcare costs dropped significantly after starting spasticity management including onabotulinumtoxinA.
This was driven by fewer hospitalizations, despite increased outpatient visits and pharmacy costs. The study did not prove the drug caused these savings.
Key findings
01Total all-cause costs decreased by 66% and spasticity-related costs by 51% in the 12 months after treatment, driven largely by reduced inpatient costs.
02Emergency department visits and hospital admissions decreased significantly, while outpatient visits to neurologists, physical medicine, and occupational therapy increased.
03Cost savings were maintained even in patients whose treatment started more than a year after their stroke, though the reduction was smaller further from the stroke event.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This was a single-arm before-and-after analysis without a control group. Patients were not randomized, and there was no comparison to patients who did not receive onabotulinumtoxinA. Claims data do not contain information on the severity of spasticity or stroke, so researchers could not match patients to a similar untreated cohort. The authors explicitly state that it is difficult to isolate the contribution of onabotulinumtoxinA to the cost savings, as patients received comprehensive spasticity management. The study did not account for indirect economic benefits like improved quality of life or reduced caregiver burden. The cohort was relatively small (735 patients) compared to the millions of records in the database, potentially introducing selection bias.
Declared interests
This study was sponsored by AbbVie, the manufacturer of onabotulinumtoxinA. Several authors are employees of the sponsor or consulting firms (Curta, Inc. and Genesis Research) that received financial support from AbbVie for this work. Other authors have received research support or consulting fees from AbbVie, Ipsen, and other pharmaceutical companies.
The easy way to misread this
Do not conclude that onabotulinumtoxinA treatment causes these cost savings. The study lacked a control group and included comprehensive spasticity management alongside the injection, so the authors state they could not isolate the drug's specific contribution to the reduced hospitalizations and costs.