Health technology assessment of using botulinum toxin type A in the settings of Russian health care in patients with neurological diseases

Botulinum toxin therapy is a complex healthcare technology with a number of features from both a clinical and regulatory point of view. More and more attention is paid to the immunogenicity of this group of biological drugs when prescribing botulinum toxin type A drugs. Also noteworthy is the expanding list of indications for medical use of drugs in this group, with indications being disclosed within individual trade names. In this regard, an assessment was made of a drug with the generic name “Botulinum toxin type A” (Xeomin) as a drug characterized by the presence of prerequisites for having the most favorable immunogenicity profile among all botulinum toxin type A drugs registered in Russia and indications for use in the treatment of sialorrhea. The methodology for assessing the healthcare technology was based on a pharmacoeconomic evaluation using cost-effectiveness analysis and Markov modeling. A number of drugs with the group name “Botulinum toxin type A-hemagglutinin complex” (Botox, Dysport, Relatox), registered in the Russian Federation, were included in the assessment as a comparison drug. The conducted assessment of the healthcare technology of using botulinum therapy for a number of conditions - spasticity, cervical dystonia, blepharospasm and sialorrhea showed the feasibility and cost-effectiveness from the perspective of the healthcare system of using the drug Botulinum toxin type A (Xeomin). It was found that the values of the incremental cost-effectiveness indicator of the drug Xeomin in the treatment of spasticity, cervical dystonia, blepharospasm and sialorrhea in terms of QALY does not exceed the value of the willingness to pay threshold. In addition, the use of the drug Xeomin in the treatment of sialorrhea prevents the development of its complication - aspiration pneumonia and the costs associated with its treatment, which can be accompanied by savings of 9,406 rubles per patient. The use of Botulinum toxin type A reduces the organizational burden on the healthcare system when applying/purchasing, transporting and storing in comparison with drugs Botu- linum toxin type A-hemagglutinin complex.