Cost Efficiency Analysis for Spasticity Management Based on Physician Botulinum Toxin Prescribing Habits

Rashid Kazerooni, Ileana Howard, Xiaomeng Li, Monica Verduzco-Gutierrez

Research output: Contribution to journalArticlepeer-review


Objective: To estimate differences in botulinum toxin type A (BoNT-A) treatment costs per patient for spasticity-injecting physicians, with a focus on physicians’ use of alternative BoNT-A agents other than onabotulinumtoxinA. Design: Retrospective cohort study. Setting: National Medicare data for fee-for-service beneficiaries in 2017. Participants: A total of 116 physicians, 6829 BoNT-A procedures, and 3051 patients were included in this analysis. Most physicians were physiatrists (84%) and used only onabotulinumtoxinA (82%). Interventions: Type of BoNT-A selected by physicians was the independent variable of interest. Included physicians were separated into 2 groups: (1) onabotulinumtoxinA only injectors and (2) abobotulinumtoxinA and/or incobotulinumtoxinA injectors (may still use onabotulinumtoxinA). Main Outcome Measure: Average cost per patient per year. Results: The total average BoNT-A cost per patient per year was significantly less for physicians who used abobotulinumtoxinA and/or incobotulinumtoxinA vs those who used only onabotulinumtoxinA ($3684 vs $4739; P=.01). Patients’ average annual out-of-pocket costs also reflected a similar difference ($855 vs $1082; P=.02) between the groups. Doses used and numbers of injections per patient per year were not significantly different between groups. Conclusions: The present analysis demonstrated lower cost per patient for both the payer and patient when physicians used types of BoNT-A other than onabotulinumtoxinA for spasticity. Nevertheless, most physicians in this spasticity-focused study used exclusively onabotulinumtoxinA, the most expensive BoNT-A available. Reasons for this are complex and include history on the market and approved indications beyond those associated with spasticity. However, future research should continue to identify such issues with a goal of finding solutions to improve cost inefficiencies.

Original languageEnglish (US)
Pages (from-to)1205-1209
Number of pages5
JournalArchives of Physical Medicine and Rehabilitation
Issue number6
StatePublished - Jun 2022


  • Botulinum toxins
  • Botulinum toxins, type A
  • Costs and cost analysis
  • Drug costs
  • Health expenditures
  • Muscle spasticity
  • Rehabilitation

ASJC Scopus subject areas

  • Rehabilitation
  • Physical Therapy, Sports Therapy and Rehabilitation


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