Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory neurogenic detrusor overactivity in children

Soo Jeong Kim, Quincy G. Nang, Arindam RoyChoudhury, Adam J.M. Kern, Kunj Sheth, Micah Jacobs, Dix Phillip Poppas, Ardavan Akhavan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Introduction: Treatment options for refractory neurogenic detrusor overactivity (NDO) in children include botulinum toxin type A (BTX-A) and augmentation cystoplasty (AC). Although BTX-A is accepted in contemporary pediatric urologic practice, cost and long-term outcomes data for BTX-A are limited relative to the gold standard, AC. The purpose of this study was to compare the projected 10-year costs of AC versus BTX-A. Methods: We performed a cost analysis from the payer perspective by computationally modeling treatment sequences by a Markov model. In the model, we used probabilities derived from published sources, and costs obtained at a tertiary medical center. The base case was a pediatric patient with refractory NDO. In the model, we assumed biannual BTX-A treatments. Treatment costs over 10 years were compared between immediate AC versus bridging therapy with BTX-A. Using the computational model, we simulated 100,000 instances of 10-year treatment cost for each of the two treatment modalities. The costs for the two treatment approaches were then compared using t-test and Wilcoxon test. Results: The projected median and mean 10-year cost of immediately AC were $51,798.72 (95% CI [$51,798.72, $327,483.80]) and $123,473.4 (SD: $98,085.23) respectfully, while the projected median and mean 10-year cost of bridging therapy with BTX-A prior to proceeding to AC as needed were $74,552.46 (95% CI [$53,188.56, $309,913.07]) and $124,858.80 (SD: $84,495.35) (p < 0.001). Conclusions: For a typical index pediatric patient with NDO, bridging therapy with intravesical BTX-A is associated with an increased cost compared to immediate AC over a ten-year period.

Original languageEnglish (US)
JournalJournal of Pediatric Urology
DOIs
StateAccepted/In press - 2022

Keywords

  • Augmentation cystoplasty
  • Intravesical botulinum toxin type A
  • Markov model
  • Neurogenic detrusor overactivity

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Urology

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