Botox injections could relieve severe dysmenorrhea and healthcare costs

Up to 16% of women of reproductive age suffer from severe dysmenorrhea, and previous studies have shown that the muscle-relaxing effect of botulinum toxin can relieve these patients when first-line treatment (analgesics and hormonal therapy) fails. A new study, initiated in France at the University of Aix-Marseille and finalized at Laval University in Quebec City, shows that this approach could also reduce the cost of treatment."At present, Botox injections remain an experimental treatment. They are not indicated for severe dysmenorrhea and are therefore not reimbursed by the public health system, in France or Quebec (or the rest of Canada)," said the first author of the study published in the Journal of Gynecology Obstetrics and Human Reproduction, Jean Martial Kouame, who hopes that his work will help change protocols.Pilot studyWith this in mind, “The team in France is finalizing a randomized clinical trial involving 300 patients, and we're in the process of seeing if we can launch one here too,” said the postdoctoral fellow in health economics at the Centre de recherche du CHU de Québec-Université Laval.The project began in Aix-en-Provence, where clinicians started from the premise that botulinum toxin's mechanism of action could have a beneficial effect on patients with painful menstruation. They backed up their hypothesis with a pilot study involving 100 women from the clinic's patient base. Kouame contributed to this study as part of his doctorate in statistics and econometrics applied to health.These failed patients were taking level 2 and 3 analgesics (anti-inflammatories, opioids) and/or a specific treatment for neuropathic pain (duloxetine, venlafaxine) and/or hormonal treatments (progestins and/or estrogens) combined with cognitive-behavioral management. With their consent, the clinician-researchers injected 200 units of Botox into the uterine muscle via hysteroscopy. The women treated with Botox experienced a significant reduction in menstrual pain. “In some cases, the pain disappeared completely, and there was no relapse for over a year. Their quality of life, including their sex life, increased considerably," said Kouame, a pharmacist by training. He noted that the Botox injection was also associated with a reduction in healthcare consumption.Substantial savingsThese women often experienced medical wandering, consulting numerous doctors and other health professionals in their quest to find a cure. As the drugs they are prescribed are not very effective, they continually change medication, said Kouame.“All this results in direct costs for the healthcare system, to which are added the indirect costs associated with work absences and reduced productivity.”Supervised by the team led by Jason Robert Guertin, professor at Université Laval's Faculty of Medicine, the Quebec component of the study involved assessing these costs using a pharmacoeconomic model that compared those of conventional treatment of severe dysmenorrhea with those of Botox injections. The estimates and calculations were made in a French context but could be applied elsewhere, said Kouame.After one year, botulinum toxin treatment would result in savings of around €1,650 ($2,500) per patient. After 10 years, savings of over €13,000 ($20,000) are reported. “A Botox treatment for severe dysmenorrhea costs around €300 ($450), but because of its efficacy and the duration of the relief it provides, it costs less than continuous medication,” he said. This article was translated from its original French and was first published in our sister publication Profession Santé.

Botox injections could relieve severe dysmenorrhea and healthcare costs

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