Cost-effectiveness of Xeomin® in the management of cervical dystonia and blepharospasm

Study objectives: Xeomin, a botulinum neurotoxin type A (BoNT/A), is licensed for the symptomatic management of blepharospasm (BP) and cervical dystonia (CD) of a predominantly rotational form (spasmodic torticollis) in adults. The objective of this study was to assess the cost-effectiveness of Xeomin from a UK NHS perspective. Methods: A cost utility analysis (CUA) against placebo and cost minimisation analysis (CMA) against other BoNT/A were conducted. The CUA utilised a Markov model with six health states, a 3.5% discount rate per annum. Direct costs were assigned in 16 cycles with the effect on quality-adjusted life years (QALYs), using data from a prospective, open-labelled cohort study. Univariate sensitivity analyses were conducted. Results: Xeomin was cost-effective versus placebo, with an incremental cost per QALY gained of GBP 6,441 in CD and GBP 3,734 in BP. Results held under sensitivity analyses. The CMA demonstrated in the majority of cases Xeomin represents the BoNT/A treatment with the lowest overall cost for CD and BP. Conclusion: Xeomin is a cost-effective treatment option relative to placebo for patients with CD and BP. Xeomin demonstrated a similar efficacy and safety profile compared to other BoNT/A at a lower overall cost. Xeomin is the only BoNT/A treatment for CD or BP to be recommended by the Scottish Medicines Consortium (SMC) for use within NHS Scotland. Xeomin has the added benefits of i) not requiring cold chain storage, and ii) its potential lower immunogenicity. Xeomin represents a cost-effective treatment choice for patients with CD and BP in the UK healthcare system.