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Cost-effectiveness of botulinum toxin a versus anticholinergic medications for idiopathic urge incontinence.

Publication ,  Journal Article
Wu, JM; Siddiqui, NY; Amundsen, CL; Myers, ER; Havrilesky, LJ; Visco, AG
Published in: J Urol
May 2009

PURPOSE: We assessed the cost-effectiveness of botulinum toxin A injection compared to anticholinergic medications for the treatment of idiopathic urge incontinence. MATERIALS AND METHODS: A Markov decision analysis model was developed to compare the costs in 2008 U. S. dollars and effectiveness in quality adjusted life-years of botulinum toxin A injection and anticholinergic medications. The analysis was conducted from a societal perspective with a 2-year time frame using 3-month cycles. The primary outcome was the incremental cost-effectiveness ratio, defined as the difference in cost (botulinum toxin A cost--anticholinergic cost) divided by the difference in effectiveness (botulinum toxin A quality adjusted life-years--anticholinergic quality adjusted life-years). RESULTS: While the botulinum strategy was more expensive ($4,392 vs $2,563) it was also more effective (1.63 vs 1.50 quality adjusted life-years) compared to the anticholinergic regimen. The calculated incremental cost-effectiveness ratio was $14,377 per quality adjusted life-year, meaning that botulinum toxin A cost $14,377 per quality adjusted life-year gained. A strategy is often considered cost-effective when the incremental cost-effectiveness ratio is less than $50,000 per quality adjusted life-year. Given this definition botulinum toxin A is cost-effective compared to anticholinergics. To determine if there are situations in which anticholinergics would become cost-effective we performed sensitivity analyses. Anticholinergics become cost-effective if compliance exceeds 75% (33% in the base case) and if the botulinum toxin A procedure cost exceeds $3,875 ($1,690 in the base case). For the remainder of the sensitivity analyses botulinum toxin A remained cost-effective. CONCLUSIONS: Botulinum toxin A injection was cost-effective compared to anticholinergic medications for the treatment of refractory urge incontinence. Anticholinergics become cost-effective if patients are highly compliant with medications or if the botulinum procedure costs increase substantially.

Duke Scholars

Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

May 2009

Volume

181

Issue

5

Start / End Page

2181 / 2186

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Incontinence, Urge
  • United States
  • Treatment Outcome
  • Sensitivity and Specificity
  • Quality-Adjusted Life Years
  • Probability
  • Middle Aged
  • Markov Chains
  • Injections, Intralesional
 

Citation

APA
Chicago
ICMJE
MLA
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Wu, J. M., Siddiqui, N. Y., Amundsen, C. L., Myers, E. R., Havrilesky, L. J., & Visco, A. G. (2009). Cost-effectiveness of botulinum toxin a versus anticholinergic medications for idiopathic urge incontinence. J Urol, 181(5), 2181–2186. https://doi.org/10.1016/j.juro.2009.01.037
Wu, Jennifer M., Nazema Y. Siddiqui, Cindy L. Amundsen, Evan R. Myers, Laura J. Havrilesky, and Anthony G. Visco. “Cost-effectiveness of botulinum toxin a versus anticholinergic medications for idiopathic urge incontinence.J Urol 181, no. 5 (May 2009): 2181–86. https://doi.org/10.1016/j.juro.2009.01.037.
Wu JM, Siddiqui NY, Amundsen CL, Myers ER, Havrilesky LJ, Visco AG. Cost-effectiveness of botulinum toxin a versus anticholinergic medications for idiopathic urge incontinence. J Urol. 2009 May;181(5):2181–6.
Wu, Jennifer M., et al. “Cost-effectiveness of botulinum toxin a versus anticholinergic medications for idiopathic urge incontinence.J Urol, vol. 181, no. 5, May 2009, pp. 2181–86. Pubmed, doi:10.1016/j.juro.2009.01.037.
Wu JM, Siddiqui NY, Amundsen CL, Myers ER, Havrilesky LJ, Visco AG. Cost-effectiveness of botulinum toxin a versus anticholinergic medications for idiopathic urge incontinence. J Urol. 2009 May;181(5):2181–2186.
Journal cover image

Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

May 2009

Volume

181

Issue

5

Start / End Page

2181 / 2186

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urinary Incontinence, Urge
  • United States
  • Treatment Outcome
  • Sensitivity and Specificity
  • Quality-Adjusted Life Years
  • Probability
  • Middle Aged
  • Markov Chains
  • Injections, Intralesional