OBJECTIVES: To conduct a cost-effectiveness analysis of abobotulinumtoxinA+standard therapy (ST), onabotulinumtoxinA+ST and standard therapy solely in patients with spastic cerebral palsy in Russia for 2-year period. Standard therapy includes сentrally acting muscle relaxant, physiotherapy, casting and orthosis. METHODS: A decision tree model used to simulate the effects of abobotulinumtoxinA, onabotulinumtoxinA and standard therapy. The data on drugs efficacy (measured as proportion of patients with spastic forms of cerebral palsy, avoided orthopedic surgery at 2nd year of therapy) was obtained from available clinical trials. In the long term, surgery in older children with cerebral palsy have lower risk of recurrence compared with the operations carried out in early childhood. In this regard, there is a particular importance of botulinum toxin therapy effect on the likelihood of reducing the frequency of the orthopedic surgeries or postponing them at a later period by reducing spasticity and prevent contractures. The following costs were taken into account: the costs of pharmacotherapy, inpatient and outpatient care, costs of adverse events, sanatorium-resort medical care, casting orthopedic surgeons, disability pensions, disable child care benefit.  RESULTS: It was revealed that the abobotulinumtoxinA+standard therapy helps to avoid surgical intervention in 93% of patients compared to 90% of patients with onabotulinumtoxinA+standard therapy and for 48% of patients with standard therapy. It was found that the regimen abobotulinumtoxinA+standard therapy has the lowest cost-effectiveness ratio (11,509 RUB/215 $) in comparison with drug therapy onabotulinumtoxinA+standard therapy (12 872 RUB/ 238 $) and standard therapy with a сentrally acting muscle relaxant without BTA (27 715 rubles/467 $) by the end of 2 years of treatment.  CONCLUSIONS: Treatment scheme abobotulinumtoxinA+standard therapy is considered the most cost-effective one for spastic cerebral palsy therapy in the Russian Federation compared with onabotulinumtoxinA+standard therapy and standard therapy solely.