title: Treatment outcomes and resource use of patients with neurogenic detrusor overactivity receiving botulinum toxin A (BOTOX) therapy in Germany.
abstract: OBJECTIVE
  To evaluate treatment outcomes and resource consumption of patients with neurogenic detrusor overactivity (NDO) before and after botulinum toxin A (Botox) therapy in Germany.
  
  
  METHODS
  In a multi-center, cross-sectional, retrospective cohort study, data of patients with NDO 12 months before and after the first Botox therapy were analyzed.
  
  
  RESULTS
  214 patients (mean age 38 +/- 14.8 years, 145 male, 69 female) with NDO due to spinal cord injury (81%); myelomeningocele (14%), or Multiple Sclerosis (5%) from seven hospitals were included. Mean interval between treatments was 8 months. Following treatment, mean maximum detrusor pressure, maximum cystometric capacity and detrusor compliance improved significantly. Prior to Botox therapy, 68% reported urinary tract infections (UTI), 63% had incontinence episodes, and 58% used incontinence aids. These numbers decreased significantly (p < 0.05) after treatment to 28, 33, and 28%, respectively. In patients using incontinence aids, mean costs per patient decreased from 2euro to 1euro per day, whereas the mean cost of drugs to treat UTIs per patient decreased from 163euro to 80euro per year, respectively.
  
  
  CONCLUSIONS
  This is the first study demonstrating the clinical usefulness of Botox therapy in clinical practice. Successful treatment resulted in lower costs for NDO associated morbidity due to less need for incontinence aids and UTI medication.
authors.affiliation: Klinik für Urologie und Kinderurologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Wefer
authors.forename: Birgit
authors.initials: B
authors.lastname: Ehlken
authors.forename: Jörn
authors.initials: J
authors.lastname: Bremer
authors.forename: Harald
authors.initials: H
authors.lastname: Burgdörfer
authors.forename: Burkhard
authors.initials: B
authors.lastname: Domurath
authors.forename: Christian
authors.initials: C
authors.lastname: Hampel
authors.forename: Johannes
authors.initials: J
authors.lastname: Kutzenberger
authors.forename: Christoph
authors.initials: C
authors.lastname: Seif
authors.forename: Karl D
authors.initials: KD
authors.lastname: Sievert
authors.forename: Karin
authors.initials: K
authors.lastname: Berger
authors.forename: Jürgen
authors.initials: J
authors.lastname: Pannek
mesh_terms: D000328:Adult; D019274:Botulinum Toxins, Type A / Q000191:economics / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008591:Meningomyelocele / Q000150:complications; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000150:complications; D011336:Probability; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000209:etiology; D053201:Urinary Bladder, Overactive / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000209:etiology; D014563:Urodynamics; D055815:Young Adult
chemical_list: D019274:Botulinum Toxins, Type A
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