Anthony G Visco1, Halina Zyczynski, Linda Brubaker, Ingrid Nygaard, Xiao Xu, Emily S Lukacz, Marie Fidela Paraiso, Jerod Greer, David D Rahn, Susan F Meikle, Amanda A Honeycutt. 1. 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.
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.
RCT Entities:
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.
Authors: Louis S Matza; Christine L Thompson; Joel Krasnow; Jessica Brewster-Jordan; Teresa Zyczynski; Karin S Coyne Journal: Neurourol Urodyn Date: 2005 Impact factor: 2.696
Authors: W F Stewart; J B Van Rooyen; G W Cundiff; P Abrams; A R Herzog; R Corey; T L Hunt; A J Wein Journal: World J Urol Date: 2002-11-15 Impact factor: 4.226