Botulinum toxin for spasticity and dystonia: utilisation analysis

Page last updated: 26 October 2018

Drug utilisation sub-committee (DUSC)

May 2018

Abstract

Purpose

To review the utilisation of botulinum toxin type A supplied through the Pharmaceutical Benefits Scheme (PBS) for the treatment of spasticity in patients with cerebral palsy or following a stroke, and for spasmodic torticollis, blepharospasm and hemifacial spasm.

Current PBS indications of botulinum toxin type A for spasticity and dystonia (abridged)

Three preparations of botulinum toxin type A are listed on the PBS: Botox^â, Dysport^âand Xeomin^â. The three preparations are not interchangeable. The units used to express the potency of botulinum toxin preparations are not equivalent.

Botox is PBS subsidised for:

• Blepharospasm or hemifacial spasm for patients aged 12 years or older.
• Spasmodic torticollis as monotherapy or as adjunctive therapy to current standard care
• Dynamic equinus foot deformity due to spasticity in ambulant patients with cerebral palsy who are aged 2 to 17 years or who commenced treatment with botulinum toxin as a paediatric patient (i.e. 2 to 17 years).
• Moderate to severe spasticity of the upper limb in patients with cerebral palsy who are aged 2 to 17 years or who commenced treatment with botulinum toxin as a paediatric patient.
• Moderate to severe spasticity of the upper limb following a stroke in adult patients meeting certain criteria. PBS subsidy is for a maximum of 4 treatment periods (total of Botox, Dysport and Xeomin) per upper limb per lifetime.

Dysport is PBS subsidised for the same indications as Botox except:

• it is not subsidised for moderate to severe spasticity of the upper limb in patients with cerebral palsy.
• the blepharospasm and hemifacial spasm listing is limited to patients aged 18 years or older, consistent with its TGA registered indication.

Xeomin is PBS subsidised for:

• Blepharospasm in patients aged 18 years or older.
• Spasmodic torticollis as monotherapy or as adjunctive therapy to current standard care in patients aged 18 years or older.
• Moderate to severe spasticity of the upper limb following a stroke in adult patients meeting certain criteria. PBS subsidy is for a maximum of 4 treatment periods (total of Botox, Dysport and Xeomin) per upper limb per lifetime.

The PBS restrictions specify that prescribing of botulinum toxin is limited to certain specialties (see Table 4 for details).

Data Sources

Pharmaceutical Benefits Scheme (PBS) prescription data for prescriptions supplied from 1 September 2015 to 31 December 2017, and Medicare Benefits Schedule (MBS) services data for injection of botulinum toxin from 1 December 1991 to 31 December 2017 were used to assess utilisation of botulinum toxin for spasticity and dystonia.

Key Findings

• In 2017, 13,116 patients were treated with PBS subsidised botulinum toxin type A for spasticity or dystonia. The number of patients receiving treatment has been increasing steadily with an approximate doubling of the number of patients receiving treatment over the past decade.
• The majority of use is for spasmodic torticollis, blepharospasm and hemifacial spasm. Use for each of these indications has been growing, with a higher rate of growth evident for spasmodic torticollis in 2016 and 2017.
• The number of patients with cerebral palsy receiving botulinum toxin for upper limb spasticity and/or foot deformity due to spasticity increased until 2015 and has now stabilised.
• In 2017, 742 patients were treated with PBS subsidised botulinum toxin for upper limb spasticity following a stroke and 1,002 prescriptions were dispensed for this indication. Utilisation of botulinum toxin post-stroke seems low in the context of all patients who have experienced a stroke and may have resultant spasticity

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