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Botox cost-effective therapy for overactive bladder
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Botox is a cost-effective and feasible first-line treatment option for overactive bladder, according to data presented at the American Urogynecologic Society 38th Annual Scientific Meeting.
“Botox is currently limited to those who have had medication failures for overactive bladder, a common condition that may affect one in three women,” J. P. Shepherd, MD, MSc, from St. Francis Medical Center, Hartford, Connecticut, told Healio Internal Medicine. “This distinction is somewhat arbitrary and was likely made due to the higher invasiveness and up-front cost of Botox compared to starting medications.”
“However, medications are often discontinued, and many patients give up before finding Botox as a treatment option,” he continued. “Likewise, Botox injection has evolved and risks of urinary retention and recurrent UTIs are likely lower than reported in earlier literature. Botox is now routinely injected in an office setting and not in the operating room. So, the treatment paradigm may need reevaluation.”
Shepherd and C. M. Carter-Brooks, from the Magee-Womens Hospital of the University of Pittsburgh Medical Center, conducted a cost-effectiveness analysis to investigate whether Botox (onabotulinumtoxinA, Allergan) would be a feasible first-line therapy for overactive bladder before anticholinergics. Participants received one of four treatment options: no treatment; receptor nonselective anticholinergic, such as tolterodine; receptor selective anticholinergic, such as solifenacin; and onabotulinumtoxinA.
The researchers used a 2-year timeframe to allow for onabotulinumtoxinA reinjection and discontinuation of anticholinergic at 2, 6 and 12 months. If efficacy was less than 50%, onabotulinumtoxinA reinjection was allowed at 6 months, but if efficacy was higher than 50%, onabotulinumtoxinA reinjection was allowed at 12 months. Carter-Brooks and Shepherd evaluated both the inclusion and exclusion of refractory untreated overactive bladder costs after treatment failure.
Data indicated that there was variation in the rank of treatment options by increasing costs based on inclusion of refractory untreated overactive bladder costs. No treatment ranked the highest in the inclusion model and lowest in the exclusion model, while the other options’ order remained the same (nonselective anticholinergic, onabotulinumtoxinA and selective anticholinergic).
In both models, the cost of onabotulinumtoxinA was more than nonselective anticholinergic and less than selective anticholinergic. Treatment with onabotulinumtoxinA was most effective; however, there were small differences between treatments in quality adjusted life years per person. OnabotulinumtoxinA, nonselective anticholinergic and selective anticholinergic were more effective than no treatment.
OnabotulinumtoxinA was cost-effective when including and excluding refractory untreated overactive bladder costs (incremental cost-effectiveness ratios, $7,756.01 and $9,764.27, respectively).
The researchers noted that urinary tract infections and retention were complications of onabotulinumtoxinA, while dry mouth, constipation and dry eyes/blurry vision were side effects of the other medications.
“We showed that [onabotulinumtoxinA] was cost-effective when compared to some medications, such as [tolterodine] and [oxybutynin], which are not specific for bladder receptors. They are older and cheaper than some more modern drugs,” Shepherd said.
“However, compared to these newer receptor specific drugs, such as [solifenacin] and [darifenacin], [onabotulinumtoxinA] was the dominant strategy, meaning that it was both more effective and less costly,” he continued. “We feel that based on these results, [onabotulinumtoxinA] should be considered as potential first-line treatment, which would radically change the way we deal with a common condition that impacts quality of life for many women.” – by Alaina Tedesco
Reference:
Carter-Brooks CM, Shepherd JP. A cost-effectiveness analysis of Botox botulinum-A toxin as first-line treatment for overactive bladder. Presented at: American Urogynecologic Society 38th Annual Scientific Meeting 2017; Oct. 3-7; Providence.
Disclosures: Carter-Brooks and Shepherd report no relevant financial disclosures.