To evaluate the cost ofboculinum toxin A (BTX-A) treatment in the Philippine setting, and determine the dose, clinical response, and adverse events to BTX-A therapy.

We identified all patients injected with BTX-A from a Movement Disorders Clinic database between May 200 1 and August 2007. Their medical records were reviewed and obtain demographic and clinical data using a standardized data collection form. The number of injections and dose given, clinical response and adverse effects, and cost of treatment were determined. Positive clinical response was defined as any degree of improvement of presenting symptoms.

A total of 1 68 patients were included, wherein 378 BTX-A injections were done. There were 85 males (50.6%). The mean age of patients was 48.0 ± 1 6.2 years old (range:7 -Sr years). The majority of patients have dystonia (n= 71, 42.2%), hemifacial spasms (n= 66, 39.3%) and spasticity (n=22, 13.1 %). Clinical improvement was documented in 89.7% (n=87) and 90.8% (n=79) of patients given with Botox® and Dysport®, respectively. The mean duration ofbenefit is 3.8 ± 1 .3 months (range: 0 - 8 months). For patients injected with Botox®, the mean duration of effect is 3.7 ± 1.1 months compared to 3.9 ± 1 .4 months for those injected with Dysport®. Adverse effects were noted in 9.5% (n= l 6) of patients. These were noted in 1 2.4% (n= 1 2) of patients injected with Botox® and 8.0% (n=8) of patients given with Dysport®. The most common adverse effect was ptosis. The overall average cost per injection is PhP 1 5,429. 1 1, while the overall mean cost of the BT)(-A alone (both with Botox® and Dysport®) per injection is PhP I 0,706.46. Of the disorders included, cervical dystonia had the highest mean expenditure of PhP 30,504.51 per injection.

Although, the cost of individual injection is high, other cost factors such as indirect and intangible costs contribute to the burden of management of these various neurologic disorders. The subjective and objective relief noted, after treatment, may compensate the expenditure with use of BTX-A.