title: Botulinum toxin treatment in neurological practice: how much does it really cost? A prospective cost-effectiveness study.
abstract: Botulinum toxin (BTA) is a safe and effective therapeutic tool for many neurological conditions but few studies have investigated its real cost in neurological practice. We evaluated the daily cost of botulinum toxin type A (BTA) treatment through a cost effectiveness analysis alongside a prospective study of BTA injections at a French University Hospital over a 2-year follow-up period. The data of 3,108 BTA injections performed in 870 adult patients presenting with dystonia, facial hemispasm, or spasticity were entered in the database. Patients were questioned at each visit about the subjective effectiveness of the previous injection. The daily cost of BTA treatment was calculated as the ratio of each session's cost (including all additional costs) to the duration of subjective efficacy. The subjective rating of efficacy duration was 17.3 ± 7.7 weeks for facial hemispasm, 15.4 ± 7.7 for blepharospasm, 14.3 ± 6.7 for cervical dystonia, 14.5 ± 7.8 and 14.1 ± 7.4 weeks for upper and lower limb spasticity, respectively. The daily cost of BTA injections was 0.57 ± 0.20 <euro> for facial hemispasm, 0.95 ± 0.30 <euro> for blepharospasm, 2.85 ± 0.86 <euro> for cervical dystonia, 3.38 ± 1.49 <euro> and 3.62 ± 1.81 <euro> for upper and lower limb spasticity, respectively. When associated costs were considered, the daily cost of BTA injections was clearly increased (45-93%) in limb spasticity or rigidity but remained only modestly increased (15-37%) in other indications. These results obtained in a large cohort of patients show that BTA treatment has a low daily cost for a long-lasting effect, with a daily cost/benefit ratio that greatly depends on the indications.
authors.affiliation: Department of Clinical Neurophysiology, Centre Hospitalier Pellegrin, Place Amélie-Rabat-Léon, 33076 Bordeaux, France. Pierre.Burbaud@chu-bordeaux.fr
authors.forename: Pierre
authors.initials: P
authors.lastname: Burbaud
authors.forename: Camille
authors.initials: C
authors.lastname: Ducerf
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Cugy
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Dubos
authors.forename: François
authors.initials: F
authors.lastname: Muller
authors.forename: Dominique
authors.initials: D
authors.lastname: Guehl
authors.forename: Patrick
authors.initials: P
authors.lastname: Dehail
authors.forename: Didier
authors.initials: D
authors.lastname: Cugy
authors.forename: Nicholas
authors.initials: N
authors.lastname: Moore
authors.forename: Alain
authors.initials: A
authors.lastname: Lagueny
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Joseph
mesh_terms: D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000379:methods; D016527:Drug Costs / Q000639:trends; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000191:economics* / Q000627:therapeutic use; D009468:Neuromuscular Diseases / Q000188:drug therapy* / Q000191:economics* / Q000503:physiopathology; D017410:Practice Guidelines as Topic / Q000592:standards; D011446:Prospective Studies
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A