Cost-Effectiveness Analysis of Anticholinergics Versus Botox for Urgency Urinary Incontinence: Results From the Anticholinergic Versus Botox Comparison Randomized Trial Journal Article

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Authors: Visco, A. G.; Zyczynski, H.; Brubaker, L; Nygaard, I.; Xu, X; Lukacz, E. S.; Paraiso, M. F.; Greer, J.; Rahn, D. D.; Meikle, S. F.; Honeycutt, A. A.
Article Title: Cost-Effectiveness Analysis of Anticholinergics Versus Botox for Urgency Urinary Incontinence: Results From the Anticholinergic Versus Botox Comparison Randomized Trial
Abstract: OBJECTIVES: This study aimed to compare the cost-effectiveness of Botox and anticholinergic (AC) medications for the management of urgency urinary incontinence (UUI). METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Journal Title: Female Pelvic Medicine Reconstructive Surgery
Volume: 22
Issue: 5
ISSN: 2151-8378
Publisher: Unknown  
Journal Place: United States
Date Published: 2016
Start Page: 311
End Page: 316
Language: ENG
DOI/URL:

10.1097/SPV.0000000000000277
Notes: LR: 20161019; GR: U10 HD041261/HD/NICHD NIH HHS/United States; GR: U01 HD041249/HD/NICHD NIH HHS/United States; GR: U10 HD054215/HD/NICHD NIH HHS/United States; GR: U10 HD054214/HD/NICHD NIH HHS/United States; GR: U10 HD041267/HD/NICHD NIH HHS/United States; GR: U10 HD069006/HD/NICHD NIH HHS/United States; GR: U10 HD069010/HD/NICHD NIH HHS/United States; GR: U10 HD054136/HD/NICHD NIH HHS/United States; GR: U10 HD054241/HD/NICHD NIH HHS/United States; GR: U10 HD041250/HD/NICHD NIH HHS/United States; JID: 101528690; NIHMS759432; OID: NLM: NIHMS759432 [Available on 09/01/17]; OID: NLM: PMC5003321 [Available on 09/01/17]; PMCR: 2017/09/01; ppublish