135 Cost-effectiveness of botulinum neurotoxin A versus surgery for drooling: a randomized clinical trial 6 quotient is a validated direct-observational semi-quantitative method to assess the severity of drooling. New saliva dripping over the lips with intervals of 15 seconds is assessed for 5 minutes, which results in a drooling quotient between 0 and 100%.15 These observations were performed by specially trained speech therapists. Caregivers were asked to report a visual analogue score, on a scale from 0 to 100, reflecting the severity of drooling over the previous 2 weeks.10,16 All participants were provided with a cost diary upon inclusion, in which they were asked to note all costs, complaints, and medical encounters (e.g. use of medication, additional visits to general practitioners, or additional hospital visits) in the 2 weeks after an intervention. Patients were asked for complications and external medical encounters 8 and 32 weeks postoperatively. Operation times and internal visits were extracted from hospital records. In this analysis of cost-effectiveness, we used a societal perspective approach, including all costs associated with the operation, admission, caregiver’s loss of productivity, community costs, caregivers’ (travel) expenses, as well as costs due to complications and follow-up. An overview of the costs included can be found in Table 1. Table 1: Overview of costs Category Cost (€) Operation rooma Day clinic stay: 294.75b Consultant/h: 120.68b Operation room team and anaesthetics team/h: 808.72 (880.17)c Material two-duct ligation: 97.37d Material botulinum neurotoxin A: 185.21d,e Tertiary carea Outpatient clinic: 174.08b Hospital stay: 685.62b Consult by telephone: consultant: 91.83b Consult by telephone: intern: 18.15b Outpatient clinic speech therapy/h: 107.96 Medicationa First prescription: 12.70 Repeated prescriptions: 6.35f
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