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

Anthony G. Visco, 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

Research output: Contribution to journalArticle

5 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)311-316
Number of pages6
JournalFemale Pelvic Medicine and Reconstructive Surgery
Volume22
Issue number5
DOIs
StatePublished - Sep 1 2016

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Cholinergic Antagonists
Urinary Incontinence
Cost-Benefit Analysis
Costs and Cost Analysis
Quality-Adjusted Life Years
Health Care Costs
onabotulinumtoxinA

Keywords

  • anticholinergic medication
  • botulinum toxin
  • cost-effectiveness
  • randomized trial
  • urge urinary incontinence

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology
  • Urology

Cite this

Cost-Effectiveness Analysis of Anticholinergics Versus Botox for Urgency Urinary Incontinence : Results from the Anticholinergic Versus Botox Comparison Randomized Trial. / Visco, Anthony G.; Zyczynski, Halina; Brubaker, Linda; Nygaard, Ingrid; Xu, Xiao; Lukacz, Emily S.; Paraiso, Marie Fidela; Greer, Jerod; Rahn, David D.; Meikle, Susan F.; Honeycutt, Amanda A.

In: Female Pelvic Medicine and Reconstructive Surgery, Vol. 22, No. 5, 01.09.2016, p. 311-316.

Research output: Contribution to journalArticle

Visco, Anthony G. ; Zyczynski, Halina ; Brubaker, Linda ; Nygaard, Ingrid ; Xu, Xiao ; Lukacz, Emily S. ; Paraiso, Marie Fidela ; Greer, Jerod ; Rahn, David D. ; Meikle, Susan F. ; Honeycutt, Amanda A. / Cost-Effectiveness Analysis of Anticholinergics Versus Botox for Urgency Urinary Incontinence : Results from the Anticholinergic Versus Botox Comparison Randomized Trial. In: Female Pelvic Medicine and Reconstructive Surgery. 2016 ; Vol. 22, No. 5. pp. 311-316.
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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.",
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