{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:37:59Z","timestamp":1760189879942,"version":"3.40.4"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T00:00:00Z","timestamp":1745193600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Food and Drug Administration, Ministry of Public Health, Thailand","award":["38\/2567"],"award-info":[{"award-number":["38\/2567"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec021\">\n<jats:title>Background<\/jats:title>\n<jats:p>Blepharospasm is a chronic facial movement disorder affecting a person\u2019s ability to work, causing depression, pain, and a reduced quality of life (QoL). Botulinum toxin type A (BoNT-A) treatment can improve these conditions; however, its cost remains a significant barrier for inclusion of this indication into the Thai National List of Essential Medicine.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec022\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>This study aimed to assess the cost-effectiveness of onabotulinumtoxinA (onaBoNT-A) and abobotulinumtoxinA (aboBoNT-A) treatment compared to oral medication treatment in patients with severe blepharospasm from a societal perspective.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec023\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A cost-utility analysis using a two-part model was conducted to analyze lifetime costs and quality-adjusted life-years (QALYs). Inputs were mainly obtained from real-world evidence of 159 Thai patients with blepharospasm. Costs and outcomes were discounted at 3% annually and presented as 2023 value. Incremental cost-effectiveness ratios (ICERs) were estimated. Deterministic and probabilistic sensitivity analyses were also conducted.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec024\">\n<jats:title>Results<\/jats:title>\n<jats:p>In comparison to standard oral medication, both onaBoNT-A and aboBoNT-A incurred greater lifetime cost (3,055 USD, 2,889 USD vs 1,926 USD) while gaining additional QALYs (6.94 years, 6.94 years vs 6.53 years). The estimated ICERs were 2,722 USD\/QALY for onaBoNT-A and 2,323 USD\/QALY for aboBoNT-A. Utility and cost of BoNT-A were important determinants in the sensitivity analysis.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec025\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Among patients with severe blepharospasm, both onaBoNT-A and aboBoNT-A were considered a cost-effective strategy under the Thai willingness to pay threshold of 4,613 USD\/QALY. Having aboBoNT-A was slightly more favorable due to lower cost, using a conversion ratio of 1U of onaBoNT-A: 3U of aboBoNT-A.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0319926","type":"journal-article","created":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T17:39:43Z","timestamp":1745257183000},"page":"e0319926","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cost-utility analysis of botulinum toxin type A versus oral drug treatment in patients with severe blepharospasm in Thailand"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7599-1991","authenticated-orcid":true,"given":"Parima","family":"Hirunwiwatkul","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6909-2789","authenticated-orcid":true,"given":"Unchalee","family":"Permsuwan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sureerat","family":"Ngamkiatphaisan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niphon","family":"Chirapapaisan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiruth","family":"Sriratanaban","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,4,21]]},"reference":[{"key":"pone.0319926.ref001","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.parkreldis.2021.09.004","article-title":"Diagnostic 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Randomized trial to determine the most appropriate location for botulinum toxin injections","volume":"104","author":"J Price","year":"1997","journal-title":"Ophthalmology"},{"key":"pone.0319926.ref013","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.jocn.2020.03.025","article-title":"Patient-reported responses to medical treatment in primary dystonia","volume":"75","author":"KA Woo","year":"2020","journal-title":"J Clin Neurosci"},{"issue":"6","key":"pone.0319926.ref014","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1212\/WNL.0000000000003596","article-title":"Dystonia treatment: Patterns of medication use in an international cohort","volume":"88","author":"S Pirio Richardson","year":"2017","journal-title":"Neurology"},{"key":"pone.0319926.ref015","author":"National Drug Information"},{"key":"pone.0319926.ref016","author":"W Techakehakit"},{"key":"pone.0319926.ref017","first-page":"S127-34","article-title":"Standard cost lists for health economic evaluation in Thailand","author":"A Riewpaiboon","year":"2014","journal-title":"J Med Assoc Thai"},{"key":"pone.0319926.ref018","first-page":"S17-26","article-title":"Measurement of costs for health economic evaluation","author":"A Riewpaiboon","year":"2014","journal-title":"J Med Assoc Thai"},{"key":"pone.0319926.ref019"},{"key":"pone.0319926.ref020","author":"Bank of Thailand"},{"issue":"Suppl 5","key":"pone.0319926.ref021","first-page":"S50-8","article-title":"Handling time in economic evaluation studies","volume":"97","author":"U Permsuwan","year":"2014","journal-title":"J Med Assoc Thai"},{"key":"pone.0319926.ref022","doi-asserted-by":"crossref","first-page":"29","DOI":"10.2147\/CEOR.S38062","article-title":"Estimating the willingness to pay for a quality-adjusted life year in Thailand: does the context of health gain matter?","volume":"5","author":"M Thavorncharoensap","year":"2013","journal-title":"Clinicoecon Outcomes Res"},{"issue":"6","key":"pone.0319926.ref023","first-page":"38","article-title":"Cost-effectiveness of Xeomin\u00ae in the management of cervical dystonia and blepharospasm","volume":"15","author":"S Chadda","year":"2009","journal-title":"EJHP Practice"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0319926","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,21]],"date-time":"2025-04-21T17:39:49Z","timestamp":1745257189000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0319926"}},"subtitle":[],"editor":[{"given":"Gang","family":"Qin","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,4,21]]},"references-count":23,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0319926","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,21]]}}}