Cost-effectiveness of botulinum neurotoxin A versus surgery for drooling: a randomized clinical trial.
Stijn Bekkers, Kim J van Ulsen, Eddy M M Adang and 2 others
PMID 32706122WHAT IT FOUND
Two-duct ligation cost more upfront but was more effective than botulinum toxin A for drooling in children with cerebral palsy.
Success rates were 63% versus 27%. The higher initial cost of surgery was offset by fewer repeat treatments, suggesting it may be more cost-effective over time.
Key findings
01Two-duct ligation had a significantly higher treatment success rate (63%) compared to botulinum toxin A (27%) at 32 weeks.
02Botulinum toxin A had lower direct costs (€1929) than two-duct ligation (€3155) per treatment cycle.
03Caregivers of children undergoing two-duct ligation reported significantly higher productivity losses (€465 vs €99) due to more time off work.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The analysis only covered one treatment cycle. Since most patients in the BoNT-A group wanted more treatment, the true long-term cost-effectiveness may favor surgery more strongly than reported. The study did not calculate Quality-Adjusted Life Years (QALYs) because the questionnaire used was not validated for quality of life, preventing a standard cost-utility analysis. Caregiver productivity loss was only captured for the first two weeks post-intervention, which may underestimate the total societal cost. The study was conducted in a single center in the Netherlands, so cost structures and clinical pathways may not generalize to other health systems.
Declared interests
The authors declared no conflicts of interest. The study was supported by non-US government funds.
The easy way to misread this
Do not assume two-duct ligation is automatically more cost-effective overall. The analysis only compared single treatment cycles. Because 92% of the botulinum toxin group requested more treatment, the actual cost of managing drooling with injections over time could be much higher than the €1929 reported, potentially changing the economic conclusion.