title: Cost-consequence analysis evaluating the use of botulinum neurotoxin-A in patients with detrusor overactivity based on clinical outcomes observed at a single UK centre.
abstract: OBJECTIVE
  This study aimed to assess the resource utilisation, health benefits and cost-effectiveness of intra-detrusor injections of botulinum neurotoxin-A (BoNT/A) in patients with overactive bladder (OAB).
  
  
  METHODS
  101 patients with urodynamically-proven detrusor overactivity of either neurogenic (NDO; n = 63) or idiopathic (IDO; n = 38) origin received intra-detrusor injections of 200-300 units of BoNT/A in 20-30 ml saline as part of a research protocol. Twenty-nine patients received repeat injections after 7-26 months. Symptom severity and urodynamic parameters were assessed at 0, 4 and 16 weeks. The cost of therapy was quantified based on the NHS resources used by typical patients and was used to calculate the cost-effectiveness of BoNT/A compared with standard care from the perspective of the UK NHS.
  
  
  RESULTS
  In an intent-to-treat analysis, 82% of patients showed a 25% or greater improvement in at least two out of five parameters (urinary frequency, urgency, urgency incontinence episodes, maximum cystometric capacity and maximum detrusor pressure) four weeks after treatment, reducing to 65% after 16 weeks. A 50% or greater improvement in the frequency of micturition, urgency or urgency incontinence was seen in 73% of patients at four weeks and 54% at 16 weeks. There were no significant differences between IDO and NDO patients in the proportion meeting these endpoints. Therapy cost pounds 826 per patient, with a cost-effectiveness ratio of pounds 617 per patient-year with > or = 25% clinical improvement.
  
  
  CONCLUSIONS
  This study demonstrates that intra-detrusor BoNT/A is an effective treatment for OAB that is highly likely to be cost-effective in both idiopathic and neurogenic disease.
authors.affiliation: The National Hospital for Neurology and Neurosurgery, London, UK.
authors.forename: Vinay
authors.initials: V
authors.lastname: Kalsi
authors.forename: Roshni B
authors.initials: RB
authors.lastname: Popat
authors.forename: Apostolos
authors.initials: A
authors.lastname: Apostolidis
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kavia
authors.forename: Isaac A O
authors.initials: IA
authors.lastname: Odeyemi
authors.forename: Helen A
authors.initials: HA
authors.lastname: Dakin
authors.forename: Juliet
authors.initials: J
authors.lastname: Warner
authors.forename: Soheir
authors.initials: S
authors.lastname: Elneil
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Fowler
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000187:drug effects; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D006113:United Kingdom; D014549:Urinary Incontinence / Q000188:drug therapy* / Q000191:economics
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A