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Reduction in Expenditures on Analgesics During
One Year of Treatment of Chronic Tension
Headache with BoNT-A
Coloprisco, DeFilippis, Santi, et al.
Posted: July 2005
Journal of Headache Pain 2003; 4:88-91
The aim of this study was to investigate the impact of
the use of botulinum toxin type A (BoNT-A; BOTOX®; Allergan, Inc.;
Irvine, CA) as preventive treatment of chronic tension-type headache
(CTTH) on analgesic use and expenditure. This was a prospective,
single-center, 1-year, open-label study of the effect of BoNT-A
treatment on acute analgesic use and expenditure in CTTH patients.
A structured headache questionnaire, which included questions about
medication costs, was completed by CTTH patients attending a
specialist headache clinic in Rome prior to BoNT-A injections.
Repeat injections were administered every 3 months for up to 1 year.
Patients were required to complete the questionnaire prior to each
injections cycle. A pharmacoeconomic analysis was performed at each
assessment to determine the effect of BoNT-A treatment on analgesic
use and expenditure. Three hundred questionnaires were distributed
and 296 were completed. The study population consisted of 201
females and 95 males.
The economic evaluation of the pharmacologic treatment of CTTH
was conducted on the 101 patients who gave complete information
on posology. Pharmacoeconomic data analysis focused on the whole
group using analgesics compared to those who self-prescribed and
those who turned to health specialists before and after treatment
with BoNT-A. Prior to treatment with BoNT-A the median monthly
pharmaceutic expenditure per patient was approximately $30 for the
whole group using analgesics, and $42 and $23 for the "self-prescribers"
and the "prescribed by specialist" groups, respectively. Median
monthly pharmaceutic expenditure decreased significantly for the
whole group, the "self-prescribers" and the "prescribed by specialist"
group (3rd month: $16, $11, $9 respectively; 6th month: $10, $11, $5
respectively; 9th month: 47, $15, $4 respectively; 12 month: $5,
$12, $4 respectively).
BoNT-A treatment produced significant reductions in both analgesic
use and expenditure. The data suggest that consultation with a
specialist would be helpful in patients with CTTH. Cooperative
studies on cost analysis of chronic daily headaches, including both
CTH and chronic migraine, comparing the economic cost package borne
by patient and community both before and after treatment with
BoNT-A, are warranted. However, in the near future additional
studies to compare clinical efficacy of BoNT-A in CTH with its
painkiller use/expenditure in the control of pain are needed in
order to avoid any possible interference due to placebo effect.