Five-year cost analysis of intra-detrusor injection of botulinum toxin type A and augmentation cystoplasty for refractory neurogenic detrusor overactivity.
OBJECTIVE
Treatment options for antimuscarinic refractory neurogenic detrusor overactivity (NDO) are botulinum toxin type A injections (BTX-A) and augmentation cystoplasty (AC). We estimated initial and cumulative 5-year costs of these treatments.


METHODS
Base case is an individual with antimuscarinic refractory NDO and decreased bladder compliance. Primary analysis is from the health care payor perspective. Model probabilities and ranges were derived from literature and chart review. Reimbursements were derived from the average of insurance carriers. Complication cost calculations were based on standard practice. Decision-analysis model was made with TreeAge Pro Healthcare 2009 Software, Inc. and rolled back for cost calculation. One-way sensitivity analysis was performed on all variables, and two-way sensitivity analyses were based on these results.


RESULTS
Average reimbursement for one BTX-A injection and AC was $2,946.83 and $25,041.53, respectively. BTX-A treatment was less expensive over 5 years, costing $28,065. The model was only sensitive within a reasonable clinical range for Botox durability. BTX-A was more cost-effective over 5 years if the effect lasted for >5.1 months. The model was based on an AC complication rate of 40%. If the PAC complication rate<14%, AC was cheaper over 5 years. The model was sensitive to surgeons costs of BTX-A ($3,027) and facility costs of BTX-A ($1,004) and AC ($17,100).


CONCLUSIONS
This is the first cost analysis of BTX-A and AC. BTX-A is cheaper at durations>5.1 months and AC was cheaper when the cost of BTX-A increases or the AC complication rate dropped below 14%.
Department of Urologic Surgery, Vanderbilt University, Nashville, TN, USA.
Priya
P
Padmanabhan
Harriette M
HM
Scarpero
Douglas F
DF
Milam
Roger R
RR
Dmochowski
David F
DF
Penson
D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D003365:Costs and Cost Analysis / Q000639:trends; D003661:Decision Support Techniques; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D007273:Injections, Intramuscular; D007349:Insurance, Health, Reimbursement / Q000191:economics; D008137:Longitudinal Studies; D015233:Models, Statistical; D009465:Neuromuscular Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D012680:Sensitivity and Specificity; D001750:Urinary Bladder, Neurogenic / Q000191:economics* / Q000628:therapy*; D053201:Urinary Bladder, Overactive / Q000191:economics* / Q000628:therapy*; D013520:Urologic Surgical Procedures / Q000191:economics / Q000379:methods*
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A