OBJECTIVES:

Botulinum toxin type A (BoNT) preparations incobotulinumtoxinA (Xeomin), abotulinumtoxinA (Dysport) and onabotulinumtoxinA (Botox) are treatments for neurological disorders, including post-stroke spasticity. Unlike other preparations, Xeomin does not require cold-chain logistics, which is associated with increased greenhouse gas (GHG) emissions. This analysis quantifies differences in environmental impact between BoNTs from a UK National Health Service (NHS) perspective.

METHODS:

GHG emissions (carbon dioxide equivalent [CO₂e]) associated with BoNTs and UK cold-chain distribution were estimated from published literature. Emissions associated with packaging (including dry ice), storage (refrigeration) and drug wastage were included; emissions associated with manufacturing, transport and disposal were assumed similar across BoNTs and excluded. Per-patient and population-level GHG emissions for post-stroke spasticity were calculated for each BoNT using a lifetime horizon. Dosing regimens were obtained from clinical trials. Treatment duration was estimated from the incidence of repeated cycles in the BoTULS trial. One tonne of CO₂e was valued at £252, per the Department for Energy, Security & Net Zero.

RESULTS:

Per-patient, Xeomin averts an estimated 16.3 and 14.8 kgCO₂e versus Dysport and Botox, respectively, for upper-limb spasticity, and 31.2 and 21.4 for lower-limb spasticity. These emissions correspond to per-patient cost savings of £4.12 and £3.73 versus Dysport and Botox, respectively, for upper-limb spasticity, and £7.87 and £5.40 for lower-limb spasticity. Versus current practice, if all post-stroke spasticity patients received Xeomin, 79,491 kgCO₂e would be averted (£20,032), equivalent to 203,779 miles driven by petrol-fueled cars.

CONCLUSIONS:

Xeomin is associated with lower per-patient and population-level GHG emissions than Dysport and Botox. Whilst these environmental benefits correspond to marginal cost savings per-patient, these may be relevant to decision-makers when alternative treatments offer similar health benefits, where marginal cost differences influence cost-effectiveness. Given the commitment to deliver a ‘Net Zero’ NHS by 2040 and considering all patients treated with BoNTs at a population-level, these benefits are increasingly relevant.