141 Cost-effectiveness of botulinum neurotoxin A versus surgery for drooling: a randomized clinical trial 6 Comparison over the three intervals separately showed lower BoNT-A costs in T1 (BoNT-A: mean €1227, 95% CI 1304–1154; two-duct ligation: mean €1942, 95% CI 2062–1829) and T2 (BoNT-A: mean €414, 95% CI 489–350; two-duct ligation: mean €941, 95% CI 1109–798) and higher costs in T3 (mean €288, 95% CI 324–256; twoduct ligation: mean €271, 95% CI 305–242). Major contributors to the difference in costs were the time spent in the operation room (T1) and caregivers’ loss of working hours (T2). The average total operation room-time was significantly lower for the BoNT-A group (mean 17min, SD 10.33) than the two-duct ligation group (mean 61min, SD 20.94), resulting in significantly lower BoNT-A operating theatre costs (mean €453) compared with two-duct ligation (mean €1049) (difference −€596, p<0.001, 95% CI −454 to −738). The sensitivity analysis for the time of the two-duct ligation procedure revealed an ICER of €31.89 per 1% gain of success at a mean surgical duration of 56 minutes, an ICER of €29.75 at 51 minutes, an ICER of €27.59 at 46 minutes, and an ICER of €25.45 at 41 minutes. We assessed the loss of working hours of the caregivers as well as estimating their contribution to the large difference in costs between the two interventions in T2. Seventy-four per cent (n=39) of the cost diaries were returned. In the BoNT-A group (n=18), 27.8% reported missing working hours; in the two-duct ligation group (n=21) this was 81.0%. There was a significant difference in loss of production: €99 for BoNT-A and €465 for two-duct ligation (difference −€392, p<0.001, 95% CI −216 to −570). Accordingly, patients treated with BoNT-A missed an average of 1.8 hours of school or work (range 0–8h, standard deviation 2.98), and the patients treated with two-duct ligation missed 23.5 hours (range 0–56, standard deviation 17.16). In 92% of patients who received BoNT-A there was a desire for further treatment at 32 weeks, compared with 22% in the two-duct ligation group. Consequently, most of the patients treated with BoNT-A required a new preoperative assessment and thus increased average costs. These costs were, however, not included in the analysis.
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