1335 - Real-World Costs of Early vs Late OnabotulinumtoxinA Treatment for Post-Stroke Spasticity: A Retrospective Claims Analysis

Objectives: Compare healthcare costs among patients with post-stroke spasticity (PSS) who received early vs late treatment with onabotulinumtoxinA (onabotA) (≤6 months vs >6 months from PSS diagnosis).

Design: This retrospective cohort analysis of patient-level claims from the IBM MarketScan^® Commercial and Medicare Supplemental Databases included adults with ≥1 onabotA claim for PSS (2010-2019). Outcomes included PSS all-cause, spasticity-related, and fall/fracture-related healthcare costs. Cost differences were analyzed at 12, 24, and 36 months after PSS diagnosis using generalized linear models, adjusting for age, sex, region, insurance type, Charlson Comorbidity Index (CCI) score, and costs prior to PSS diagnosis. 847 patients were analyzed at 12 months (early: 485[57%]; late: 362[43%]).

Results: Early initiators were older (mean age 54.4 vs 47.8), had a larger Medicare population (33% vs 23%), and higher CCI score (1.9 vs 1.5) than late initiators. OnabotA use was higher for early vs late initiators at 12 months (mean injections, 2.3 vs 1.2), 24 months (3.2 vs 2.7) and comparable by 36 months (4.1 vs 3.9). All-cause and spasticity-related costs were lower for early initiators at 12 (adjusted difference: −$47,409, −$16,375), 24 (−$77,054, −$23,609), and 36 months (−$88,159, −$25,655) vs late initiators (all P< 0.01). At 12 months, early initiators had lower spasticity-related outpatient (−$3,693;P< 0.01), inpatient (−$5,658), pharmacy (−$133), and ED costs (−$37) than late initiators. The proportion of patients with falls (adjusted odds ratio [OR]: 0.46;P< 0.01) or fractures (OR: 0.53;P=0.03) was lower for early vs late initiators at 12 months. Falls/fractures costs were lower for early initiators (−$3,035). Similar findings were observed at 24- and 36-months.

Conclusions: Early initiators had lower total all-cause and spasticity-related costs over 12, 24, and 36 months. These findings suggest that onabotA may reduce healthcare costs when used earlier vs later for eligible patients with PSS.