Botulinum toxin treatment in neurological practice: how much does it really cost? A prospective cost-effectiveness study


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 € for facial hemispasm, 0.95 ± 0.30 € for blepharospasm, 2.85 ± 0.86 € for cervical dystonia, 3.38 ± 1.49 € and 3.62 ± 1.81 € 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.

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We thank Professor M.C. Saux and Dr. M. Bonin who managed the supply of Botulinum toxin in the Bordeaux hospital pharmacy as well as R. Cooke for his comments on the manuscript.

Conflict of interest

The Bordeaux University Hospital funded the study in the context of an audit of good professional practice. All authors declare (1) no support from any company for the submitted work; (2) no relationships with any companies that might have an interest in the submitted work in the previous 3 years; (3) no nonfinancial interests that may be relevant to the submitted work.

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Correspondence to Pierre Burbaud.

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Burbaud, P., Ducerf, C., Cugy, E. et al. Botulinum toxin treatment in neurological practice: how much does it really cost? A prospective cost-effectiveness study. J Neurol 258, 1670–1675 (2011).

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  • Botulinum toxin
  • Dystonia
  • Spasticity
  • Cost effectiveness study