{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T13:40:19Z","timestamp":1790948419444,"version":"4.1.0"},"reference-count":19,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2020,7,24]],"date-time":"2020-07-24T00:00:00Z","timestamp":1595548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Johanna Kinderfonds, Arnhem, the Netherlands"},{"name":"Phelps Stichting voor spastici, Bussum, the Netherlands"},{"name":"Stichting Rotterdams Kinderrevalidatie Fonds Adriaanstichting, Rotterdam, the Netherlands"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>This study compared the cost\u2010effectiveness of botulinum neurotoxin A (BoNT\u2010A) injections with two\u2010duct ligation of the submandibular glands as treatment for severe drooling after one treatment cycle.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>The study was part of a larger, partly single\u2010blinded, randomized clinical trial (trialregister.nl identifier NTR3537). Data were collected between 2012 and 2017. Evaluation was at 32\u00a0weeks after one treatment cycle. Fifty\u2010seven patients with cerebral palsy or other neurological, non\u2010progressive disorders and severe drooling classified as having a drooling frequency \u22653 or a drooling severity \u22652, in whom conservative treatment was deemed ineffective, were randomized to treatment by BoNT\u2010A or two\u2010duct ligation. An incremental cost\u2010effectiveness ratio (ICER) was calculated using the success rates as the measure of benefit. Treatment success was defined as a decrease \u226550% from baseline to 32\u00a0weeks in the subjective visual analogue scale for the severity of drooling or the objective drooling quotient.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010three patients were analysed (22 females, 31 males; mean age 11y, range 8\u201322y). Average costs for one treatment cycle, which included one BoNT\u2010A injection, were \u20ac1929 (standard error 62) for BoNT\u2010A and \u20ac3155 (standard error 99) for two\u2010duct ligation. Treatment success was in favour of two\u2010duct ligation (63% vs 27%; number needed to treat 3). The ICER was \u20ac34 per 1% gain in treatment success in favour of two\u2010duct ligation versus BoNT\u2010A.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>The additional cost of two\u2010duct ligation is to some extent offset by a larger treatment success rate compared with BoNT\u2010A.<\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Botulinum neurotoxin A (BoNT\u2010A) is less expensive per percentage of success than two\u2010duct ligation.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>The additional cost of two\u2010duct ligation over BoNT\u2010A is offset by greater treatment success.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1111\/dmcn.14636","type":"journal-article","created":{"date-parts":[[2020,7,24]],"date-time":"2020-07-24T09:49:26Z","timestamp":1595584166000},"page":"1302-1308","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Cost\u2010effectiveness of botulinum neurotoxin A versus surgery for drooling: a randomized clinical trial"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8330-9243","authenticated-orcid":false,"given":"Stijn","family":"Bekkers","sequence":"first","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kim J","family":"van Ulsen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eddy","family":"M M Adang","sequence":"additional","affiliation":[{"name":"Department for Health Evidence Rehabilitation Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur","family":"R T Scheffer","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"J A van den Hoogen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology and Head and Neck Surgery Radboud University Medical Center Nijmegen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mrr.0000194395.64396.f1"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0012162206000235"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431-005-1759-z"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2016.06.043"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/archoto.2010.147"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.134.5.470"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.13333"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2014.06.005"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14510"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000007081"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-09735-1"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2019.04.036"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02412423"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/dmcn.14391"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2012.04428.x"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2003-1104-L"},{"key":"e_1_2_7_18_1","unstructured":"Zorginstituut Nederland.Richtlijn voor het uitvoeren van economische evaluaties in de gezondheidszorg.Diemen 2016."},{"key":"e_1_2_7_19_1","volume-title":"opdracht van Zorginstituut Nederland. Geactualiseerde versie","author":"Hakkaart\u2010van Roijen L","year":"2016"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12146"}],"container-title":["Developmental Medicine &amp; Child Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fdmcn.14636","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dmcn.14636","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/dmcn.14636","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/dmcn.14636","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,2]],"date-time":"2023-09-02T13:10:52Z","timestamp":1693660252000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/dmcn.14636"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,24]]},"references-count":19,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1111\/dmcn.14636"],"URL":"https:\/\/doi.org\/10.1111\/dmcn.14636","archive":["Portico"],"relation":{},"ISSN":["0012-1622","1469-8749"],"issn-type":[{"value":"0012-1622","type":"print"},{"value":"1469-8749","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,24]]},"assertion":[{"value":"2020-06-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-07-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}