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.

Botulinum toxin as treatment for focal dystonia: a systematic review of the pharmaco-therapeutic and pharmaco-economic value

“…Yearly costs of botulinum toxin treatment for FD ranged from EUR 347 to EUR 3,633, depending on number of treatment sessions per year and type of dystonia treated [4, 5, 7, 10, 13]. The lowest costs were for treating BPS patients three times a year and the highest for treating CD patients five times a year [5, 10].…”

“…The lowest costs were for treating BPS patients three times a year and the highest for treating CD patients five times a year [5, 10]. Yearly costs for not treating FD patients were estimated to be between EUR 248 and EUR 1,014 and consisted of visits to the outpatient clinic, other medication and physiotherapy, among others [4, 13].…”

“…This leads to yearly costs ranging from EUR 419.75 for occupational dystonia to EUR 1,197.20 for cervical dystonia. Subjective improvement in these patients varied between 2.2 and 2.4 on a four-point rating scale [5]. …”

Cost-effectiveness analysis of abobotulinumtoxinA for the treatment of cervical dystonia in the United Kingdom

“…The importance of CD’s effect on productivity has been recognized previously, although studies have not generally quantified it suitably for subsequent use in economic evaluations. For instance, a study of almost 300 patients by the Finnish Dystonia Association32 found 97 subjects (39%) had retired because of CD at a median age of 48 years, while many others reported sick leave, reduced productivity, and loss of employment 14,33. Similarly, a second study found 53.3% of patients with CD reported that employment status was negatively affected through reduced hours or responsibilities, including 18.9% of patients who had lost employment due to CD symptoms 15…”

A retrospective study to assess resource utilization in patients with cervical dystonia in the United Kingdom

“…In France, the annual cost of treating CD for patients who required BoNT-A injections in a neurological practice was estimated at, on average, €1,198 (2010), which included pharmaceutical costs of the BoNT-A injections and other medications, salaries, and conditioning and injection equipment. Differences in costs across patients were explained by the frequency of BoNT-A administration and duration of effect 22. However, at the present time, there are no other European studies that have estimated the overall economic burden of CD, including the UK.…”