OnabotulinumtoxinA Indications and Utilization Among Older Patients with Medicare: A Cross-Sectional Analysis

OnabotulinumtoxinA (onabotA) is a neurotoxin that is FDA approved to treat multiple indications. However, data regarding the burden of these indications and onabotA utilization among older adults are limited. This analysis examined the prevalence of onabotA-approved indications and the proportion of those patients treated with onabotA in adults ≥65 years of age in Medicare Fee-for-Service (FFS; 2023) and Medicare Advantage (MA; 2022). Proportions of patients diagnosed with and treated for ≥2 indications were also estimated. Among FFS enrollees, 6.1% of patients were diagnosed with ≥1 indication and 7.0% of diagnosed patients received onabotA. Urological indications (3.2%) and spasticity (2.5%) were most commonly diagnosed, and <5% of patients diagnosed with either of these indications received onabotA. Among patients diagnosed with ≥1 onabotA-approved indication, 7.4% were diagnosed with ≥2 indications. Concomitant diagnosis of urological indications and spasticity was common (>80%), and concomitant treatment of these indications was among the lowest (~5%). Differences in diagnosis and onabotA treatment rates by age, sex, and Medicaid eligibility were observed. OnabotA treatment rates among MA enrollees were lower. Among older adults, the most commonly diagnosed onabotA-approved indications had the lowest onabotA treatment rates, suggesting a potential gap between disease burden and real-world treatment utilization.