OBJECTIVES: The uses of botulinum neurotoxin, through their ability to block acetylcholine release at neuromuscular junctions, were recognized in 2008 by the American Academy of Neurology through its published guidelines on cervical dystonia. The aim of this study is to conduct a systematic review and meta-analysis of the cost-utility evidence of the incobotulinumtoxin-A in cervical dystonia.

METHODS: A systematic literature search was performed for („incobotulinumtoxin A” and „cervical dystonia”) among all English language articles from inception to 07/31/2019 in MEDLINE, Embase, Cochrane Central, and Web of Science, and citations within reviewed articles to evaluate the impact of incobotulinumtoxin-A treatment on economic and clinical outcomes. Studies were eligible if they assessed the cost-effectiveness of incobotulinumtoxin-A and reported incremental cost-effectiveness ratios. Risk of bias and quality assessment was assessed based on the Consolidated Health Economic Evaluation Reporting Standard checklist. Incremental net benefits (INBs) were estimated, and meta-analysis was applied to pool INBs across studies, using the fixed-effects model if there was no heterogeneity by an inverse variance method.

RESULTS: We identified 37 studies, of which 3 studies were eligible. 2 were in English and 1 in Spanish. All three studies performed cost-utility analysis, using quality-adjusted life-years. Two studies compared incobotulinumtoxin-A with onabotulinumtoxin-A and one study compared incobotulinumtoxin-A with abobotulinumtoxin-A. All the studies concluded the cost-effectiveness of incobotulinumtoxin-A in cervical dystonia. We calculated the INB for each study using the GDP for each country from the two studies ($30,371 for Spain and $49,971 for Australia). The meta-analysis was done based on comparator onabotulinumtoxin-A of the study. The pooled INB was estimated at $1,642 (95% CI, $1,556-$1,735).

CONCLUSIONS: Our meta-analysis found that the pooled INBs are greater than 0, indicated that the introduction of incobotulinumtoxin-A for cervical dystonia may be cost-effective with a gain of $1,642 by introducing incobotulinumtoxin-A, compared with onabotulinumtoxin-A.