title: Cost-Effectiveness Analysis of Anticholinergics Versus Botox for Urgency Urinary Incontinence: Results From the Anticholinergic Versus Botox Comparison Randomized Trial.
abstract: This study aimed to compare the cost-effectiveness of Botox and anticholinergic (AC) medications for the management of urgency urinary incontinence (UUI).
  
  
  
  Cost and effectiveness data were analyzed from participants in the Anticholinergic versus Botox Comparison randomized trial of daily AC medication versus 100 U of intradetrusor Botox injection. Societal costs included the following: treatment costs, patient costs, and medical and nonmedical utilization during the 6-month trial. Quality-adjusted life-years (QALYs) were calculated based on questionnaire-derived utility measures and annualized based on data collected at baseline through 6 months. We also estimated the average direct costs for each treatment through 9 months - the duration of time when approximately half the Botox participants maintained adequate symptom control.
  
  
  
  Data were analyzed on the 231 women who completed a 6-month follow-up in the Anticholinergic versus Botox Comparison trial (119 AC and 112 Botox). The mean reduction in UUI episodes per day was not significantly different per group. The cumulative mean direct costs through the first 6 months also were similar: $1339 for the AC group and $1266 for the Botox group with AC costs exceeding Botox costs after 5 months. Both groups had considerable QALY gains. Annualizing the 6-month trial results to a 12-month measure, the AC and Botox groups averaged 0.702 and 0.707 QALYs, respectively. Estimates through 9 months favored Botox, showing that AC participants incurred a higher cost per month of adequate symptoms control ($305) compared with Botox participants ($207).
  
  
  
  Botox and AC medications have similar costs and effectiveness in the first 6 months of UUI treatment. If costs and outcomes are considered through 9 months, Botox may have significantly lower costs but similar UUI symptom control as AC.
authors: From the *Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC; †University of Pittsburgh, Pittsburgh, PA; ‡Departments of Obstetrics & Gynecology and Urology, Stritch School of Medicine, Loyola University, Chicago, IL; §Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT; ∥Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI; ¶Department of Reproductive Medicine, UC San Diego Health Systems, San Diego, CA; **Department of Obstetrics and Gynecology, Cleveland Clinic, Cleveland, OH; ††Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL; ‡‡Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX; §§Gynecologic Health and Disease Branch, The Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD; and ∥∥RTI International, Research Triangle Park, NC, for the Pelvic Floor Disorders Network.
authors: Anthony G
authors: AG
authors: Visco
authors: Halina
authors: H
authors: Zyczynski
authors: Linda
authors: L
authors: Brubaker
authors: Ingrid
authors: I
authors: Nygaard
authors: Xiao
authors: X
authors: Xu
authors: Emily S
authors: ES
authors: Lukacz
authors: Marie Fidela
authors: MF
authors: Paraiso
authors: Jerod
authors: J
authors: Greer
authors: David D
authors: DD
authors: Rahn
authors: Susan F
authors: SF
authors: Meikle
authors: Amanda A
authors: AA
authors: Honeycutt
mesh_terms: D065087:Acetylcholine Release Inhibitors / Q000008:administration & dosage / Q000191:economics*; D000368:Aged; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000191:economics*; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D053202:Urinary Incontinence, Urge / Q000188:drug therapy*
chemical_list: D065087:Acetylcholine Release Inhibitors; D018680:Cholinergic Antagonists; D019274:Botulinum Toxins, Type A