130 CHAPTER 6 ABSTRACT Aim This study compared the cost-effectiveness of injections of botulinum neurotoxin A (BoNT-A) with two-duct ligation of the submandibular glands as treatment for severe drooling after one treatment cycle. Methods The study was part of a larger, partly single-blinded, randomized clinical trial (trialregister.nl identifier NTR3537). Data were collected between 2012 and 2017. Evaluation was at 32 weeks after one treatment cycle. Fifty-seven patients with cerebral palsy or other neurological, non-progressive disorders and severe drooling classified as having a drooling frequency ≥ 3 or a drooling severity ≥ 2, in whom conservative treatment was deemed ineffective, were randomized to treatment by BoNT-A or two-duct ligation. An incremental cost-effectiveness ratio (ICER) was calculated using the success rates as the measure of benefit. Treatment success was defined as a decrease ≥ 50% from baseline to 32 weeks in the subjective visual analogue scale for the severity of drooling or the objective drooling quotient. Results Fifty-three patients were analysed (22 females, 31 males; mean age 11y, range 8–22y). Average costs for one treatment cycle, which included one BoNT-A injection, were €1929 (standard error 62) for BoNT-A and €3155 (standard error 99) for twoduct ligation. Treatment success was in favour of two-duct ligation (63% vs 27%; number needed to treat 3). The ICER was €34 per 1% gain in treatment success in favour of two-duct ligation versus BoNT-A. Interpretation The additional cost of two-duct ligation is to some extent offset by a larger treatment success rate compared with BoNT-A.
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