OBJECTIVES: Botulinum neurotoxin type A is effective in managing cervical dystonia (CD), a disorder causing painful and involuntary contraction of neck and shoulder muscles and abnormal posture in middle-aged adults. However, the cost-effectiveness of abobotulinumtoxinA for the treatment of CD in the United Kingdom (UK) has not been evaluated. METHODS: A Markov model was developed from the UK payer perspective to evaluate the cost-effectiveness of abobotulinumtoxinA compared to best supportive care (BSC) with a lifetime horizon and health states for response, non-response, secondary non-response and BSC in CD patients (mean age: 53 years; 37%  male population). The clinical improvement in Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) was mapped to utility using the data from the randomized Phase III trial of abobotulinumtoxinA (NCT00288509). Healthcare resource costs and other model inputs were obtained from British National Formulary, Personal Social Services Research Unit, published literature or clinical experts. Costs and outcomes were discounted at 3.5% per annum. RESULTS: The incremental lifetime quality adjusted life years (QALY) gained in the abobotulinumtoxinA arm compared to BSC was 0.25 per patient, whereas the incremental cost was ₤6,234, corresponding to an incremental cost-effectiveness ratio of £24,936 per QALY. One-way sensitivity analyses showed that the results are sensitive to the proportion of responders to abobotulinumtoxinA at first injection, duration of the reinjection interval, the number of cycles of reinjection allowed amongst primary non-responders and any difference in TWSTRS value at baseline that may exist between patients in BSC and abobotulinumtoxinA arm. Probabilistic sensitivity analysis showed abobotulinumtoxinA to be cost-effective 41% of times in 5000 Monte Carlo simulations, at a threshold of ₤20,000 per QALY. CONCLUSIONS: Using abobotulinumtoxinA in adult patients with CD was not only found to be cost-effective at an acceptable willingness-to-pay threshold in the UK but also provides additional quality of life gains.