OBJECTIVES: Botulinum toxin A (BTA) injections are indicated for the management of neurological movement disorders, including arm spasticity (AS) and cervical dystonia (CD). This study calculated the cost per care episode for two BTA: Botox® and Dysport®. The analysis was completed for 20 countries around the world. METHODS: Doses of BTA are expressed in non-interchangeable units : Botox® is available in "Allergan units" whereas Dysport® is provided in 500 "Speywood units”. Recommended dosages were derived from country SmPCs/PIs. Cost analysis was based on official list prices and expressed in 2011 euros, using exchange rates as of end of May 2011. The cost per care episode was calculated using available recommended dosages for each product (country’s own or average of other countries) combined with price per vial in each country. RESULTS: For AS, recommended total injection dosage per patient for Dysport is 1000 units in all countries where indicated in SmPCs; for Botox®, it is 300U per patient based on recommended dosages in the USA and France. For CD, dosages for Dysport® are 500U per patient; whereas 200U of Botox® is recommended per patient. Considered with the respective prices per vial in each country, Dysport® cost per patient per care episode for AS was less than Botox® in 17 (89%) of the 19 countries (average 15% less across countries). The difference was 20% or higher in nearly half (47%) of countries. In CD, these differences were even greater with Dysport® cost per patient was 40% or less versus Botox in 45% of countries (average 36% less across countries). CONCLUSIONS: Considering cost per patient per care episode based on recommended dosages in SmPCs/PIs, Dysport® remains cheaper versus Botox in most countries. When extrapolated to a national level, substantial savings could be realized by using Dysport® in the treatment of AS and CD.