Effectiveness of type A botulinum toxins for aesthetic indications and their relative economic impact

It is accepted that the three commercially available type A botulinum toxins (BoNT-As) are different, their units of potency are not interchangeable and no fixed dose conversion ratio exists between them. To date, there is no clear evidence demonstrating the superiority of one toxin over another clinically.

The study aims to identify evidence confirming the equivocal efficacy of the formulations and to justify that attention can therefore be reasonably turned to their differing costs as a means of aiding choice of treatment. This is achieved via the development of the cost calculator presented herein, to enable direct economic comparisons to be made between the three commercially available BoNT-A formulations licensed for aesthetic indications in the UK.

An online literature search using PubMed was undertaken and the latest available information on the cost for each BoNT-A treatment was accessed via the British National Formulary (BNF). Predicated on the evidence review, a cost calculator was developed which takes into account for the glabella: the number of treatments needed per patient with each product over a year and the number of treatments available with differing dilutions of each vial of each product over a year. A range of cost prices can also be introduced allowing a direct cost-comparison to be made for treating the glabella of a set number of patients over a year between different products.

Azzalure(®) (abobotulinumtoxinA) was the most cost-effective in almost all scenarios tested, whilst Vistabel(®) (onabotulinumtoxinA) was the least cost-effective. Of the two products with published non-inferiority with respect to each other, onabotulinumtoxinA and Bocouture(®) (incobotulinumtoxinA), incobotulinumtoxinA offered a lower overall cost to treat the glabella of the same number of patients when compared with Vistabel.

In most scenarios, BoNT-A treatment with abobotulinumtoxinA will result in significant annual cost savings when compared with treatment with onabotulinumtoxinA or incobotulinumtoxinA.