OBJECTIVES: To estimate the annual cost of treatment of adult patients with blepharospasm, cervical dystonia and upper limb spasticity after stroke with onabotulinumtoxin A (Botox^®) and incobotulinumtoxin A (Xeomin^®) in Spain, considering mean doses from real-world clinical practice.

METHODS: After conducting a literature review of published real-world studies, comparative studies of Botox^® and Xeomin^® were selected. A cost-analysis model was developed in Microsoft Excel, using the available doses of each study. Mean doses were identified for blepharospasm (47±10 U, Botox^®; 62±11 U, Xeomin^®), cervical dystonia (127±19 U, Botox^®; 144±23 U, Xeomin^®) and upper limb spasticity (183±99 U, Botox^®; 235±108 U, Xeomin^®). The administration frequency considered was every 12 weeks (4.3 annual sessions). The annual pharmaceutical cost per patient (€,2018) was calculated considering the lower ex-factory reference price per unit in Spain of the available botulinum toxin A presentations (€0.8526/U, both). No drug wastage was assumed. Several sensitivity analyses (SA) were carried out.

RESULTS: The estimated annual costs per patient were €173.65 (Botox^®) and €229.07 (Xeomin^®) for blepharospasm, €469.21 (Botox^®) and €532.02 (Xeomin^®) for cervical dystonia and €676.11 (Botox^®) and €868.23 (Xeomin^®) for upper limb spasticity after stroke. Botox^® treatment is estimated to result in lower costs of 24.2%, 11.81% and 22.1%, in each one of the indications, respectively, compared to Xeomin^®