E-Posters-10241_Carter

10241_Carter_Brooks

Pdf Summary

This study aimed to determine whether Botox is a cost-effective option for first-line treatment of overactive bladder (OAB), even before prescribing anticholinergic (ACH) medication. A cost-effectiveness analysis (CEA) model was used to compare different treatment options for OAB, including no treatment, receptor non-selective ACH (i.e. tolterodine), receptor selective ACH (i.e. solifenacin), and intra-detrusor Botox injections. The model considered a 2-year timeline and accounted for discontinuation of ACH at different time points, Botox reinjection, and one switch between ACH drugs. Multiple efficacy levels and complications were also factored in. The analysis measured effectiveness in terms of quality-adjusted life years (QALYs) and calculated the incremental cost-effectiveness ratio (ICER) to determine cost-effectiveness.<br /><br />The results showed that Botox had the highest effectiveness (QALYs), although the differences between strategies were small. Botox costs were higher than non-selective ACH but lower than selective ACH. Compared to selective ACH, Botox was found to be more effective and cost-effective. Botox ICERs were well below willingness-to-pay thresholds. The model predicted that patients on non-selective ACH would use it for an average of 14.32 months, while those on selective ACH would use it for 15.57 months. Botox, on the other hand, would require 2.24 injections over the 2-year period. The analysis was considered robust, as the results remained unchanged even after varying the inputs for model variables.<br /><br />However, there were some limitations to the analysis, such as not allowing crossover between therapies and not including other treatments like pelvic floor physical therapy, behavioral modifications, neuromodulation, and mirabegron. In conclusion, the study found that Botox is a cost-effective therapy for the first-line treatment of OAB, and selective ACH are no longer cost-effective when Botox is included as an option. The authors recommend further exploration of Botox as a treatment option for OAB, even before attempting ACH medications.

Keywords

Botox

overactive bladder

cost-effective

first-line treatment

anticholinergic medication

cost-effectiveness analysis

tolterodine

solifenacin

intra-detrusor Botox injections

quality-adjusted life years