Background: Port-wine stains are congenital vascular abnormalities that impact children’s and parents’ quality of life (QoL). There are currently no established criteria for assessing the quality of life in PWS patients. Utility measures such as willingness-to-pay (WTP) and time trade-off (TTO) can be used to quantify disease burden, impact on QoL, and assess the cost-effectiveness of interventions. Methods: This was a cross-sectional questionnaire-based survey study in Thailand from July 2021 to April 2022. The questionnaire included sociodemographic data and preference-based measurement, WTP and TTO. The primary outcome was a WTP and TTO for PWS laser treatment. The subsample analysis for the primary outcome was based on gender (male and female) and age (< 5 years and ≥ 5 years). The household income was measured for time trade-off outcome. Results: Out of 46 respondents, WTP for the base case at 40% improvement cost 6109.01 baht per visit. Patients were willing to spend their time 9.95 hours per visit for a clinical improvement of 40%. Female was willing to pay and spend more time than male, while those aged≥ 5 years were willing to pay and spend more time than those aged < 5 years. High household income > 100k per month willing to spend less time than lower income groups. Conclusion: There were obvious correlations between WTP and TTO with clinical outcomes. Utility indicators such as WTP and TTO can be used to measure disease burden, impact on QoL, and assess the cost-effectiveness of interventions. WTP and TTO could provide a more personalized approach to improving QoL, considering each patient’s unique treatment plan and priority. This could help with patient uncertainty and long-term planning strategies to increase the QoL cost-effectively.

Objective Botulinum toxin serotype A (BoNT/A) is widely used for minimal invasive aesthetic treatments. Different brands of BoNT/A exhibit structural variations. The aim of this study was to compare the duration and efficacy of various BoNT/A brands available in Thailand for reducing bite force and treating wrinkles. Methods Fifty participants were randomly assigned to one of five groups, with each group receiving a different BoNT/A brand, namely, incobotulinumtoxinA (IncoA), onabotulinumtoxinA (OnaA), abobotulinumtoxinA (AboA), letibotulinumtoxinA (LetiA), and prabotulinumtoxinA (PraboA). BoNT/A was administered to the masseter muscle and the upper face. Bite force was measured before injection and at 2, 4, 8, 12, 16, 20, and 24 weeks post-injection. Evaluation scores for wrinkle improvement were assessed after the treatment. Results The most significant reduction in bite force occurred between 2 and 4 weeks post-injection. PraboA demonstrated the most substantial reduction in bite force, while IncoA had the least effect. However, the percentage of bite force reduction did not exhibit statistical significance between BoNT/A types. Additionally, the reduction in bite force for all BoNT/A types was reversed at 4 months post-injection. More than half of the participants experienced improvement beyond 16 weeks. Conclusions The structural differences among BoNT/A brands did not significantly affect the longevity and efficacy of bite force reduction and wrinkle treatment. Trial Registration ClinicalTrials.gov identifier: TCTR20211205001 (registered 4 Dec 2021).

Botulinum toxin type A (BoNT/A) formulations differ in their content of non-toxic accessory proteins, also known as complexing proteins (CPs), which may influence immunogenicity. Some BoNT/A products share structurally similar CPs, potentially leading to antibody cross-reactivity among formulations. This prospective study investigated whether patients treated with different BoNT/A products develop cross-reactive anti-CP antibody responses. One hundred participants were allocated into five treatment groups, each receiving a single BoNT/A formulation: incobotulinumtoxinA (IncoA), onabotulinumtoxinA (OnaA), abobotulinumtoxinA (AboA), letibotulinumtoxinA (LetiA), or prabotulinumtoxinA (PraboA). Each participant received 50 units or equivalent dosing. Serum samples were collected 180 days post-injection, and anti-CP antibodies were quantified using an absorption ELISA and compared with a toxin-naïve control group. IncoA did not induce significant anti-CP antibody responses. In contrast, higher antibody levels were observed in the OnaA, LetiA, and PraboA groups against multiple CPs, suggesting structural similarity and cross-reactivity. AboA primarily induced antibodies directed against its own CPs and those of PraboA. These findings demonstrate that CP-containing formulations can induce cross-reactive antibody responses, whereas CP-free incobotulinumtoxinA exhibits minimal immunogenicity. This study highlights the importance of CP composition in guiding clinical product selection, particularly in patients requiring repeated BoNT/A administration.