144 CHAPTER 6 we can only partly assess the community costs directly related to the intervention. This might be an underestimation, as it is plausible that there would also have been loss of working hours during the baseline and follow-up visits during the whole treatment cycle. Furthermore, one could speculate on the generalizability of our analysis of costeffectiveness because this RCT was conducted in a single tertiary-care centre, in a single country. However, because of micro-costing, we present a better outlook on the total costs per intervention which might make our results more applicable to other health care centres. Moreover, ours is the only Dutch centre specializing in both treatments, so our analysis of cost-effectiveness is representative of the Dutch community. In conclusion, this study presents the first insight into the costs included in the treatment of drooling. Drooling is a well-known problemwith severe consequences. The use of BoNT-A injections is well established and although two-duct ligation has gained popularity, it is a relatively new, unknown treatment modality.10,12,19 This article reveals that BoNT-A is slightly less expensive whereas there is a greater treatment response with a presumed longer-term effect after two-duct ligation, so its costs generally only have to be paid once for a ‘lifetime solution’. The results in this study show that two-duct ligation is equal in costs after about 1.5 BoNT-A injections. We conclude that the additional cost of two-duct ligation is to some extent offset by a larger treatment success proportion than BoNT-A. Future research should, however, confirm this and focus both on the long-term costs and on the effect of both treatments over multiple cycles.11,12 Acknowledgements We thank Peter Jongerius, who performed all the BoNT-A injections. We also thank Karen van Hulst, Marloes Lagarde, Sandra de Groot, Corrie Erasmus, Corinne Delsing, and Saskia Kok, who had a role in acquiring the data. The authors have stated that they had no interests that might be perceived as posing a conflict or bias.
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