title: Cost-utility analysis of botulinum toxin type A products for the treatment of cervical dystonia.
abstract: OBJECTIVE
  A cost-utility analysis of botulinum toxin type A products for the treatment of cervical dystonia (CD) was conducted.
  
  
  METHODS
  A cost-utility analysis of botulinum toxin type A products was conducted from the U.S. government perspective using a decision-analysis model with a one-year time horizon. Probabilities of the model were taken from several studies using the three botulinum type A products approved by the Food and Drug Administration for the treatment of CD: onabotulinumtoxinA (Botox), abobotulinumtoxinA (Dysport), and incobotulinumtoxinA (Xeomin). The main outcome measurement was successful treatment response with botulinum toxin type A, measured in quality-adjusted life years (QALYs). Response was defined as a patient who experienced improvement of CD symptoms without a severe adverse event. Probabilistic sensitivity analysis was conducted to test robustness of the base-case results.
  
  
  RESULTS
  All three botulinum toxin type A agents were cost-effective at a willingness-to-pay threshold of $100,000 per QALY. Xeomin was the most cost-effective with a cost-effectiveness ratio of $27,548 per QALY. Xeomin was dominant over the alternative agents with equivalent efficacy outcomes and lower costs. Dysport had the second lowest cost-effectiveness ratio ($36,678), followed by Botox ($49,337). The probabilistic sensitivity analysis supported the results of the base-case analysis. Dysport was associated with the lowest wastage (2.2%), followed by Xeomin (10%) and Botox (22.9%).
  
  
  CONCLUSIONS
  A cost-utility analysis found that Xeomin was the more cost-effective botulinum toxin type A product compared with Botox and Dysport for the treatment of CD. Wastage associated with the respective products may have a large effect on the cost-effectiveness of the agents.
authors: Rashid Kazerooni, Pharm.D., BCPS, is Pharmacoeconomics Program Manager, Veterans Affairs San Diego Healthcare System, San Diego, CA. Christine Broadhead, B.S.N., RN, is Critical Care Nurse, Sharp HealthCare, San Diego. rashidkazerooni@hotmail.com.
authors: Rashid
authors: R
authors: Kazerooni
authors: Rashid Kazerooni, Pharm.D., BCPS, is Pharmacoeconomics Program Manager, Veterans Affairs San Diego Healthcare System, San Diego, CA. Christine Broadhead, B.S.N., RN, is Critical Care Nurse, Sharp HealthCare, San Diego.
authors: Christine
authors: C
authors: Broadhead
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D004305:Dose-Response Relationship, Drug; D016527:Drug Costs; D006801:Humans; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D019057:Quality-Adjusted Life Years; D014103:Torticollis / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C542869:abobotulinumtoxinA; C545476:incobotulinumtoxinA