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Cost comparison between botulinum neurotoxin and surgery in the treatment of infantile esotropia in a tertiary public hospital

OBJECTIVE: To compare the cost implications of botulinum neurotoxin (BNT) injection to surgery in infantile esotropia (IE) in a public/government funded hospital. METHODS AND ANALYSIS: A simple costing comparison was undertaken for a randomised clinical trial in IE. Patients were randomised to recei...

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Autores principales: Mayet, Ismail, McGee, Shelley-Ann, Ally, Naseer, Alli, Hassan Dawood, Tikly, Mohammed, Williams, Susan Eileen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217941/
https://www.ncbi.nlm.nih.gov/pubmed/34250258
http://dx.doi.org/10.1136/bmjophth-2021-000766
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author Mayet, Ismail
McGee, Shelley-Ann
Ally, Naseer
Alli, Hassan Dawood
Tikly, Mohammed
Williams, Susan Eileen
author_facet Mayet, Ismail
McGee, Shelley-Ann
Ally, Naseer
Alli, Hassan Dawood
Tikly, Mohammed
Williams, Susan Eileen
author_sort Mayet, Ismail
collection PubMed
description OBJECTIVE: To compare the cost implications of botulinum neurotoxin (BNT) injection to surgery in infantile esotropia (IE) in a public/government funded hospital. METHODS AND ANALYSIS: A simple costing comparison was undertaken for a randomised clinical trial in IE. Patients were randomised to receive either BNT or standard surgery. The participants in the BNT arm were further subdivided into subgroups based on their age in months and degree of esotropia in prism dioptres (PD) at presentation: G1 ≤60 PD/24 months, G2 ≤24 months/>60 PD, G3 >24 months/≤60 PD, G4 >24 months/>60 PD. The costs were calculated for each arm from primary treatment to eventual satisfactory outcome defined as orthophoria or microtropia (≤10 PD). A bottom-up costing analysis was done for single and multiple procedures for each arm. Comprehensive variable costs as well as fixed costs were calculated at each point of intervention and expressed in local currency ZAR (US$1=ZAR15.00). Costing was analysed for surgery and BNT subgroups (based on clinical success) RESULTS: There were 101 patients enrolled in the trial. 54 in the BNT arm and 47 in the surgery arm. Cost for single surgery and single BNT was ZAR 7743.04 and 1713.14, respectively. A favourable clinical outcome was achieved in 72% of surgery arm and 37% of BNT arm. The mean cost for eventual favourable outcome in BNT arm was ZAR9158.08 and in surgery arm ZAR9124.27 (p=0.26). Mean cost in G1 was ZAR6328.45, in G2 ZAR7197.45, in G3 ZAR11891.93 and G4 ZAR12882.44 (p=0.018). CONCLUSION: BNT has a cost–benefit in IE and is a viable option in the primary treatment of IE in resource constrained regions. Clinical outcomes and economic benefit in smaller angle of esotropia and younger patients are comparable to surgery.
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spelling pubmed-82179412021-07-09 Cost comparison between botulinum neurotoxin and surgery in the treatment of infantile esotropia in a tertiary public hospital Mayet, Ismail McGee, Shelley-Ann Ally, Naseer Alli, Hassan Dawood Tikly, Mohammed Williams, Susan Eileen BMJ Open Ophthalmol Paediatric Ophthalmology OBJECTIVE: To compare the cost implications of botulinum neurotoxin (BNT) injection to surgery in infantile esotropia (IE) in a public/government funded hospital. METHODS AND ANALYSIS: A simple costing comparison was undertaken for a randomised clinical trial in IE. Patients were randomised to receive either BNT or standard surgery. The participants in the BNT arm were further subdivided into subgroups based on their age in months and degree of esotropia in prism dioptres (PD) at presentation: G1 ≤60 PD/24 months, G2 ≤24 months/>60 PD, G3 >24 months/≤60 PD, G4 >24 months/>60 PD. The costs were calculated for each arm from primary treatment to eventual satisfactory outcome defined as orthophoria or microtropia (≤10 PD). A bottom-up costing analysis was done for single and multiple procedures for each arm. Comprehensive variable costs as well as fixed costs were calculated at each point of intervention and expressed in local currency ZAR (US$1=ZAR15.00). Costing was analysed for surgery and BNT subgroups (based on clinical success) RESULTS: There were 101 patients enrolled in the trial. 54 in the BNT arm and 47 in the surgery arm. Cost for single surgery and single BNT was ZAR 7743.04 and 1713.14, respectively. A favourable clinical outcome was achieved in 72% of surgery arm and 37% of BNT arm. The mean cost for eventual favourable outcome in BNT arm was ZAR9158.08 and in surgery arm ZAR9124.27 (p=0.26). Mean cost in G1 was ZAR6328.45, in G2 ZAR7197.45, in G3 ZAR11891.93 and G4 ZAR12882.44 (p=0.018). CONCLUSION: BNT has a cost–benefit in IE and is a viable option in the primary treatment of IE in resource constrained regions. Clinical outcomes and economic benefit in smaller angle of esotropia and younger patients are comparable to surgery. BMJ Publishing Group 2021-06-21 /pmc/articles/PMC8217941/ /pubmed/34250258 http://dx.doi.org/10.1136/bmjophth-2021-000766 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Paediatric Ophthalmology
Mayet, Ismail
McGee, Shelley-Ann
Ally, Naseer
Alli, Hassan Dawood
Tikly, Mohammed
Williams, Susan Eileen
Cost comparison between botulinum neurotoxin and surgery in the treatment of infantile esotropia in a tertiary public hospital
title Cost comparison between botulinum neurotoxin and surgery in the treatment of infantile esotropia in a tertiary public hospital
title_full Cost comparison between botulinum neurotoxin and surgery in the treatment of infantile esotropia in a tertiary public hospital
title_fullStr Cost comparison between botulinum neurotoxin and surgery in the treatment of infantile esotropia in a tertiary public hospital
title_full_unstemmed Cost comparison between botulinum neurotoxin and surgery in the treatment of infantile esotropia in a tertiary public hospital
title_short Cost comparison between botulinum neurotoxin and surgery in the treatment of infantile esotropia in a tertiary public hospital
title_sort cost comparison between botulinum neurotoxin and surgery in the treatment of infantile esotropia in a tertiary public hospital
topic Paediatric Ophthalmology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217941/
https://www.ncbi.nlm.nih.gov/pubmed/34250258
http://dx.doi.org/10.1136/bmjophth-2021-000766
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