1.1 Xeomin (botulinum neurotoxin type A) is recommended, within its marketing authorisation, as an option for treating chronic sialorrhoea caused by neurological conditions in adults. It is recommended only if the company provides it according to the commercial arrangement.
Why the committee made these recommendations
Chronic sialorrhoea (excessive salivation and drooling) happens when neurological conditions cause problems with swallowing. Treatment is usually standard (non-drug) care such as using bibs, speech and language therapy, and occupational therapy. But some people may take anticholinergic drugs to reduce the amount of saliva produced.
Randomised controlled trial evidence shows that Xeomin reduces the amount of saliva produced. The evidence suggests that this does not improve quality of life. However, it seems that the benefit of Xeomin on quality of life might not have been fully captured in the trial because of the way that quality of life was assessed.
Taking into account the unmeasured benefits in the evidence means that the cost-effectiveness estimates are within the range that NICE usually considers a cost-effective use of NHS resources. Therefore, Xeomin is recommended.