title: Economic evaluation of botulinum toxin versus thoracic sympathectomy for palmar hyperhidrosis: data from a real-world scenario.
abstract: BACKGROUND
  Local botulinum toxin injections and endoscopic thoracic sympathectomy (ETS) have shown clinical effectiveness for the treatment of palmar hyperhidrosis in several studies. Although both strategies cause considerable costs for health-care systems, at the moment there are no studies examining directly their cost-effectiveness performance. The aim of the study was to assess the incremental cost-effectiveness of botulinum toxin when compared with ETS for palmar hyperhidrosis.
  
  
  METHODS
  Costs, effectiveness, and incremental cost-effectiveness ratio (ICER) were calculated. Costs were assessed from a Spanish National Health System perspective in a historical cohort of patients with palmar hyperhidrosis attending a tertiary referral hospital. Effectiveness was evaluated by using the Hyperhidrosis Disease Severity Scale (HDSS). A responder was defined as a patient who reported at least a two-grade improvement on the HDSS scale with respect to the baseline value. The horizon of time was 1 year.
  
  
  RESULTS
  Effectiveness was greater for ETS (n = 128) when compared with botulinum toxin (n = 100) for the treatment of palmar hyperhidrosis (92% vs. 68%; odds ratio (OR) = 6.22 [2.80, 13.80]; absolute risk ratio (ARR) = -0.24 [-0.45, -0.14]; number-needed-to-treat (NNT) = -4 [-2, -11]). Botulinum toxin had an ICER of 125 € when compared with ETS during the first year of treatment.
  
  
  CONCLUSIONS
  In this retrospective real-world observational sample of patients with palmar hyperhidrosis, treatment with ETS appears to be more effective and less costly when compared with botulinum toxin during the first year of treatment. Analyses such as this give decision makers the tools to choose a better treatment option which is both highly effective and yet has a low cost.
authors.affiliation: Department of Pharmacy, Reina Sofia University Hospital, Avda. Menéndez Pidal s/n, 14004 Córdoba, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Isla-Tejera
authors.forename: Juan
authors.initials: J
authors.lastname: Ruano
authors.forename: María A
authors.initials: MA
authors.lastname: Alvarez
authors.forename: Teresa
authors.initials: T
authors.lastname: Brieva
authors.forename: Manuel
authors.initials: M
authors.lastname: Cárdenas
authors.forename: Carlos
authors.initials: C
authors.lastname: Baamonde
authors.forename: Angel
authors.initials: A
authors.lastname: Salvatierra
authors.forename: José-Ramón
authors.initials: JR
authors.lastname: Del Prado-Llergo
authors.forename: José C
authors.initials: JC
authors.lastname: Moreno-Giménez
keywords: Botulinum toxin; Endoscopic thoracic sympathectomy; Incremental cost-effectiveness analysis; Palmar hyperhidrosis