132 CHAPTER 6 INTRODUCTION Drooling is a well-known problem in children with neurodevelopmental disabilities. It can cause physical and psychosocial problems for the patient as well as damage personal belongings.1–3 It is detrimental to quality of life and is associated with notable health care costs.4 Currently, when conservative treatment (speech and language therapy or behavioural therapy) has failed, intraglandular injection of botulinum neurotoxin A (BoNT-A) is the treatment of first choice. The procedure is effective in 46.6% of children. Side effects occur in 33% of patients, but these are usually mild and subside within a few weeks. The effect of BoNT-A injections is always temporary and lasts for a median of 22 weeks.5–7 Over the past two decades, ligations of the submandibular and/or parotid ducts have gained popularity. These procedures are attractive as they are technically straightforward, require little operative time, and can take place in a day-case setting.8,9 Compared with submandibular gland excision or duct re-routing, duct ligation is associated with less postoperative morbidity.6 More specifically, recent literature has reported that two-duct ligation was effective in more than 60% of patients after 32 weeks, and there were limited complaints and risks of serious adverse events related to the procedure (4%).9–12 Analyses of cost-effectiveness are becoming increasingly popular as instruments to facilitate health care decision-making. The cost-effectiveness of a health care intervention is determined by opportunity cost and benefit gains. The costs and cost-related effectiveness of the different treatments for drooling are currently unknown. This study aimed to compare the cost-effectiveness of BoNT-A treatments with the two-duct ligation intervention for the treatment of drooling in patients with neurodisabilities after one treatment cycle of 32 weeks.
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