191 on daily life, daily care, social interaction, and self-esteem (i.e. quality of life). BoNT-A This thesis showed that BoNT-A was effective in approximately half of the patients after eight weeks and a quarter of the patients after 32 weeks. AEs and complaints after BoNT-A were temporary and relatively limited (8% dysphagia and 4% diminished feeding due to nausea), and there were no severe adverse events. Moreover, there seemed a significant relief in the impact of drooling on daily life and care and material damage. Health care and community cost for a single bilateral submandibular BoNT-A injection were significantly lower than for 2-DL. This thesis confirms that submandibular BoNT-A is effective for treating anterior drooling, with significant relief of the impact of drooling on daily life and care wherein the costs are relatively low. There is only a limited risk for adverse events and postoperative complaints. Although there might be some loss of effect after repeated injections, there is continued improvement in the vast degree of patients. Cost-effectiveness Although hospital and community costs after 2-DL are significantly higher for 2-DL, the treatment effect after 2-DL is higher and longer-lasting than BoNT-A. After 1.5 injections, costs are equal, and to maintain treatment effect after BoNT-A injections are required yearly. Hence, 2-DL is likely to be cost-effective in the long term compared to multiple BoNT-A injections. The decision for the treatment of drooling is dependent on various variables. BoNT-A, in our institution, is predominantly used in children who still have the chance to ‘outgrow’ drooling because of its temporary potency. In general, after 8 years, we perceive it as less likely that children ‘outgrow’ drooling. We offer surgical treatment to children with drooling refractory to conservative measures after the age of 8 years. The findings in this cost-effectiveness analysis support this approach from an economic perspective.
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