Costs of treating dystonias and hemifacial spasm with botulinum toxin A

Botulinum toxin (BTX) has become a safe and effective therapeutic tool in the treatment of a variety of neurological disorders, especially dystonias. One major disadvantage, however, is the high cost of a single injection of BTX. In this study of 835 patients, we calculated the cost of treatment with BTX serotype A (BTX-A) for different dystonias and hemifacial spasm. The annual expenditure per patient for BTX-A injections in this cohort totalled (mean +/- standard deviation) 1030 Deutschmarks (DM) [1996 values] +/- DM610 [$US570 +/- $US340; 230 +/- 130 pounds sterling (pound)] for blepharospasm (n = 158), DM1450 +/- DM1520 ($US800 +/- $US830; pound 310 +/- pound 280) for craniocervical dystonia (n = 148), and DM1480 +/- DM780 ($US810 +/- $US430; pound 330 +/- pound 180) for oromandibular dystonia (n = 16), while the treatment of cervical dystonia consumed DM4590 +/- DM2060 ($US2520 +/- $US1130; pound 960 +/- pound 420) [n = 362] per patient. In order to alleviate symptoms in patients with hemifacial spasm (n = 151), DM510 +/- DM270 ($US280 +/- $US150; pound 110 +/- pound 60) had to be spent annually. The expenses for surgical therapy for cervical dystonia were DM10 120 +/- DM1900 (n = 54). No major differences concerning expenditure could be found in this study between the 2 available preparations of BTX. However, there appeared to be a lower rate of adverse effects with the Botox(R) formulation, compared with the Dysport(R) formulation, of BTX-A (this difference was statistically significant, i.e. p <0.001). Although the cost of an individual injection is high, other cost factors also substantially contribute to the societal costs of adult-onset dystonias. Some of these costs may be attenuated with the use of BTX. The subjective and objective relief of these socially devastating and sometimes painful conditions rewards the expenditure associated with the use of BTX-A.