137 Cost-effectiveness of botulinum neurotoxin A versus surgery for drooling: a randomized clinical trial 6 applicable.17,18 If reference prices were unavailable or inaccurate for our analysis, cost price calculations were applied, using a micro-costing approach. Medication costs outside the hospital were estimated using the average price per prescription line or the price for standard packages in the case of over-the-counter medication.19 Hours of absence at work reported by parents or caregivers weremultiplied with the standard price for average productivity costs per hour for paid workers. For visits to the drooling centre, the average distance to the patients’ homes was calculated; for other health care-related transportation, we used standard distances. These distances were multiplied with a standard rate of euros per kilometre. Parking costs were added to every hospital visit. Cost estimates were adjusted for inflation using the annual Dutch consumer price index for 2019. Direct costs included costs for the surgical procedure, material, visits to day clinics, outpatient appointments, medication, and visits to the general practitioner or local hospitals. Indirect costs include costs incurredby patients or caregivers for transportation, childcare, and sick leave. All costs were assigned to three different time intervals. The first interval (T1) consisted of the preliminary work-up for undergoing the procedure, which included visits to the speech and language therapist, otolaryngologist, and anaesthetic outpatient clinic, and the costs made during the intervention and the medicine that was prescribed per protocol. The second interval (T2) included additional costs due to complications, such as additional hospital visits, consultations by telephone or medication changes up to 8 weeks postoperatively, and the follow-up visit at 8 weeks. We also added costs for the lost productivity of the parents, as well as costs for additional childcare due to the operation. We used mean imputation in the case of missing cost diaries for loss of productivity and additional childcare. The third interval (T3) contained any additional health-related costs that occurred between the 8- and 32-week follow-up visit and the 32-week follow-up visit. Statistical analysis Cost-effectiveness was calculated using the proportion of success from the RCT. Descriptive statistics were computed for our patients’ characteristics, using means and ranges where appropriate. Pearson’s χ2 tests were used to analyse whether there was a significant difference in success between the two treatments and the
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