Policy number: SRP 022
Policy name: Conditions involving the use of Botulinum Toxin
Status: Individual Funding Approval
Effective date: 1 April 2024
Next review date: 1 April 2026
Whilst Botulinum Toxin (BT) is no longer an excluded drug, Mid and South Essex ICB only funds interventions involving the use of BT on a restricted basis, and only in line with the East of England Priorities Advisory Committee recommendations (2022) and NICE guidance. In line with NICE principles, the product with the lowest acquisition cost within licensed indications will be funded.
The ICB do not commission the use of Botulinum Toxin (BT) for cosmetic use.
Treatment of the following conditions involving the use of BT will be funded using products licensed for the condition:
- Chronic anal fissure in adults
- Severe blepharospasm in adults
- Hemi-facial spasm in adults
- Cervical dystonia of a predominantly rotational form (spasmodic torticollis) in adults
- Hyperhidrosis – see separate SRP 143 on Hyperhidrosis
- Focal spasticity in adults. including those with stroke, with focal or multifocal spasticity where there is a dynamic spastic component (as opposed to contracture) and there are anticipated functional gains in line with Royal College of Physician guidance
- Achalasia – only in patients with high risk of perforation with pneumatic dilatation treatment
- Frey’s Syndrome – facial hyperhidrosis secondary to parotidectomy
- Dysphagia caused by achalasia in patients at high risk of perforation during pneumatic dilatation treatment or aspiration. Not for dysphagia resulting from any other condition.
- Hirschsprung’s disease
- Overactive bladder only when non-pharmaceutical and pharmaceutical pathway Guidelines for management of urinary incontinence (MSEMOC).pdf has proven unsuccessful
- Disease induced hypersalivation (NOT drug induced)
- Migraine Positive in line with NICE technology appraisal guidance (TA260), issued June 2012
Note: Spasticity treatment in paediatric cerebral palsy (lower and upper limb) is commissioned by NHSE although this may change through delegation of specialised commissioning.
MSE ICB will only fund a maximum of 4 treatments per annum for commissioned treatments except for the following treatments where the maximum frequency of funded treatments is as stated:
| Chronic anal fissure | Single use |
| Achalasia | 6 monthly |
| Frey’s syndrome | 6 monthly |
| Hyperhidrosis | 6 monthly |
| Overactive bladder | 6 monthly |
References:
- East of England Priorities Advisory Committee-Botulinum toxin Type A Guidance September 2022
- Botulinum toxin type A for the prevention of headaches in adults with chronic migraine Technology Appraisal 260 (TA260); issued June 2012- https://www.nice.org.uk/guidance/ta260
- Spasticity in children and young adults with non-progressive brain disorders, Clinical Guideline 145 (CG145), issued July 2012. https://www.nice.org.uk/guidance/cg145
- Urinary incontinence in neurological disease: assessment and management Clinical Guideline 148 (CG148), issued August 2012 https://www.nice.org.uk/guidance/CG148
- Lower urinary tract symptoms in men, (CG97), Issued May 210; updated June 2015 https://www.nice.org.uk/guidance/cg97
- Urinary incontinence and pelvic organ prolapse in women: management NICE guideline [NG123] Published date: April 2019 https://www.nice.org.uk/guidance/ng123