Background There are various types of botulinum toxin type A. There is no defined relationship in the equivalent power between them.

Purpose To analyse botulinum toxint type A (Dysport 500 U and Botox 50–100 U) usage for different indications, and to propose the one with the most favourable cost/efficiency ratio.

Material and methods Different indications for which botulinum toxin type A was used were analysed from January to December 2013 in a third tier hospital.

Results Distribution of Botox treated indications by service was as follows: neurology: migraines (38), spasmodic torticollis (9), blepharospasm (8) and spasticity (6); rehabilitation: spasmodic torticollis (28), hyperhidrosis (7), hemifacial spasm (28) and spasticity (75); dermatology: hyperhidrosis (26); urology: urinary incontinence due to neurogenic bladder (2). Dysport was used by the rehabilitation service to treat spasticity (132) and spasmodic torticollis (6).

In spasmodic torticollis cases, the recommended Botox dose per patient and session is 240 U compared with 500 U for Dysport. Cost of Botox is 309.2€ versus 173.6€ for Dysport. Dysport implies theoretical savings of 43.85% per patient. During the studied period, of 43 patients suffering from spasmodic torticollis, 6 were treated with Dysport and 37 with Botox.

In arm/leg spasticity cases, both were used. The recommended dosage of Botox per patient and session is 200–500 U compared with 750–1500 U for Dysport. Costs with Botox would be 309.2–618.5€ versus 347.2–520.8€ for Dysport. Hence Botox presents a theoretical saving of 10.9% per patient for low dosages, while with Dysport, savings are 15.8% in high dose cases.

For other indications (75 patients) Botox was exclusively used because it was the only toxin with the approved indication or because it is the choice in these indications in our hospital.

Conclusion Botox allows better economic dosage when few units are needed, as in cases of blepharospasm, hemifacial spasm or minor spasticity.

For spasmodic torticollis and major spasticity, Dysport is the most cost effective option.

References and/or Acknowledgements Botox and Dysport Summary of Product Characteristics.

No conflict of interest.