Optimal botulinum toxin therapy of dystonia in Germany: what would it cost?

Botulinum toxin (BT) therapy is the therapy of choice for most forms of dystonia. We want to describe its costs, if all dystonia patients in Germany would have access to optimal BT therapy. For this, we combined the latest data on epidemiology of dystonia and dosing of BT therapy for dystonia. Missing data were generated for this study. Based on official German pharmacy sales prices, optimal treatment for all dystonia patients in Germany with a population of 84.1 million would generate annual drug costs of €155.5 million (cervical dystonia 89.3, tardive dystonia 22.1, generalised dystonia 17.9, blepharospasm 9.3, segmental dystonia 5.9, writer's cramp 5.3, arm dystonia 3.2, oromandibular dystonia 2.3, musician's dystonia 0.3, spasmodic dysphonia 0.1) This is €1.85 annually per capita or 0.3% of the total 2021 drug budget and 42% of the 2021 Parkinson drug budget of German public insurance companies. Actual costs for the health care system are considerably lower, as there are various discounts to consider. Further reductions would be possible. BT therapy's individual costs are high. Its costs for the health care system, however, are marginal. Comparing projected and actual costs, would allow estimating availability and quality of BT therapy of dystonia in Germany.