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.

中文翻译：

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某三级公立医院小儿内斜视肉毒毒素与手术治疗费用比较

目的比较一家公立/政府资助医院注射肉毒杆菌神经毒素 (BNT) 与手术治疗婴儿内斜视 (IE) 的成本影响。方法和分析 对 IE 中的一项随机临床试验进行了简单的成本计算比较。患者被随机分配接受 BNT 或标准手术。BNT 组的参与者根据他们的年龄（月）和就诊时的棱镜屈光度 (PD) 内斜视程度进一步细分为亚组：G1 ≤60 PD/24 个月，G2 ≤24 个月/>60 PD，G3 >24月/≤60 PD，G4 >24 月/>60 PD。计算了从初级治疗到最终令人满意的结果（定义为正斜视或小斜视（≤10 PD））的每个组的成本。对每个手臂的单个和多个程序进行了自下而上的成本分析。在每个干预点计算综合可变成本和固定成本，并以当地货币 ZAR（1 美元 = ZAR15.00）表示。对手术和 BNT 亚组的成本进行了分析（基于临床成功） 结果共有 101 名患者参加了试验。BNT 组 54 例，手术组 47 例。单次手术和单次 BNT 的费用分别为 ZAR 7743.04 和 1713.14。72% 的手术组和 37% 的 BNT 组取得了良好的临床结果。BNT 组最终有利结果的平均成本为 ZAR9158.08，手术组为 ZAR9124.27 (p=0.26)。G1 中的平均成本为 ZAR6328.45、G2 ZAR7197.45、G3 ZAR11891.93 和 G4 ZAR12882.44 (p=0.018)。结论 BNT 在 IE 中具有成本效益，是资源有限地区 IE 初级治疗的可行选择。