title: Cost-effectiveness of botulinum toxin a versus anticholinergic medications for idiopathic urge incontinence.
abstract: OBJECTIVE
  We assessed the cost-effectiveness of botulinum toxin A injection compared to anticholinergic medications for the treatment of idiopathic urge incontinence.
  
  
  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.
authors.affiliation: Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina 27710, USA. Jennifer.wu@duke.edu
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Wu
authors.forename: Nazema Y
authors.initials: NY
authors.lastname: Siddiqui
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Amundsen
authors.forename: Evan R
authors.initials: ER
authors.lastname: Myers
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.forename: Anthony G
authors.initials: AG
authors.lastname: Visco
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000191:economics* / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000191:economics* / Q000627:therapeutic use; D017046:Cost Savings; D003362:Cost-Benefit Analysis / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006801:Humans; D015552:Injections, Intralesional; D008390:Markov Chains; D008875:Middle Aged; D011336:Probability; D019057:Quality-Adjusted Life Years; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014481:United States; D053202:Urinary Incontinence, Urge / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics
chemical_list: D018680:Cholinergic Antagonists; D019274:Botulinum Toxins, Type A