223 setting under general anaesthesia. Fifty-three children and adolescents with severe drooling (Drooling Frequency score ≥3 or Drooling Severity score ≥2), aged 8 years and older, with cerebral palsy or any other nonprogressive neurodisabilities were analyzed according to the intention-to-treat principle. A parent questionnaire on the severity of drooling in specific positions and daily activities and the impact on daily life and care was filled out at baseline and 8 and 32 weeks posttreatment. This chapter confirms reduced drooling by both BoNT-A and bilateral submandibular duct ligation but provides new evidence on improvedwell-being through a reduction in drooling. Even though there is a greater risk of complications and morbidity after bilateral submandibular duct ligation than BoNT-A, there was a significantly greater and longer-lasting positive effect on most outcomes. Chapter 6 The costs and cost‐related effectiveness of the different treatments for drooling are currently unknown. The aim of chapter 6 was to compare the cost‐effectiveness of injections of botulinum neurotoxin A (BoNT‐A) with submandibular duct ligation (2-DL) of the submandibular glands as a treatment for severe drooling after one treatment cycle. This study is part of a larger, partly single-blinded, randomized clinical trial of which the methodology is reported in chapter 2. Fifty-three patients were randomized to treatment by BoNT-A or 2-DL. An incremental cost‐ effectiveness ratio (ICER) was calculated using the success rates as the measure of benefit. Treatment success was defined as a decrease of ≥50% from baseline to 32 weeks in the subjective visual analog scale for the severity of drooling or the objective drooling quotient. Average costs for one treatment cycle, which included one BoNT‐A injection, were €1929 (standard error 62) for BoNT‐A and €3155 (standard error 99) for two‐duct ligation. Treatment success was in favour of 2-DL (63% vs 27%; number needed to treat 3). The ICER was €34 per 1% gain in treatment success in favor of 2-DL versus BoNT‐A. This article reveals that BoNT‐A is slightly less expensive. In contrast, there is a greater treatment response with a presumed longer‐term effect after 2-DL, so its costs generally only have to be paid once for a ‘lifetime solution’. The results in this study show that 2-DL is equal in costs after about 1.5 BoNT‐A injections. We conclude that the additional cost
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