Document Detail

Cost-consequence analysis evaluating the use of botulinum neurotoxin-A in patients with detrusor overactivity based on clinical outcomes observed at a single UK centre.
MedLine Citation:
PMID:  16413656     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE(S): This study aimed to assess the resource utilisation, health benefits and cost-effectiveness of intra-detrusor injections of botulinum neurotoxin-A (BoNT/A) in patients with overactive bladder (OAB).
METHODS: 101 patients with urodynamically-proven detrusor overactivity of either neurogenic (NDO; n = 63) or idiopathic (IDO; n = 38) origin received intra-detrusor injections of 200-300 units of BoNT/A in 20-30 ml saline as part of a research protocol. Twenty-nine patients received repeat injections after 7-26 months. Symptom severity and urodynamic parameters were assessed at 0, 4 and 16 weeks. The cost of therapy was quantified based on the NHS resources used by typical patients and was used to calculate the cost-effectiveness of BoNT/A compared with standard care from the perspective of the UK NHS.
RESULTS: In an intent-to-treat analysis, 82% of patients showed a 25% or greater improvement in at least two out of five parameters (urinary frequency, urgency, urgency incontinence episodes, maximum cystometric capacity and maximum detrusor pressure) four weeks after treatment, reducing to 65% after 16 weeks. A 50% or greater improvement in the frequency of micturition, urgency or urgency incontinence was seen in 73% of patients at four weeks and 54% at 16 weeks. There were no significant differences between IDO and NDO patients in the proportion meeting these endpoints. Therapy cost pounds 826 per patient, with a cost-effectiveness ratio of pounds 617 per patient-year with > or = 25% clinical improvement.
CONCLUSION(S): This study demonstrates that intra-detrusor BoNT/A is an effective treatment for OAB that is highly likely to be cost-effective in both idiopathic and neurogenic disease.
Vinay Kalsi; Roshni B Popat; Apostolos Apostolidis; Rajesh Kavia; Isaac A O Odeyemi; Helen A Dakin; Juliet Warner; Soheir Elneil; Clare J Fowler; Prokar Dasgupta
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2005-12-22
Journal Detail:
Title:  European urology     Volume:  49     ISSN:  0302-2838     ISO Abbreviation:  Eur. Urol.     Publication Date:  2006 Mar 
Date Detail:
Created Date:  2006-02-22     Completed Date:  2006-09-07     Revised Date:  2012-03-07    
Medline Journal Info:
Nlm Unique ID:  7512719     Medline TA:  Eur Urol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  519-27     Citation Subset:  IM    
The National Hospital for Neurology and Neurosurgery, London, UK.
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MeSH Terms
Aged, 80 and over
Botulinum Toxins, Type A / administration & dosage,  economics,  therapeutic use*
Cost-Benefit Analysis
Great Britain
Injections, Intramuscular
Middle Aged
Muscle, Smooth / drug effects
Neuromuscular Agents / therapeutic use*
Urinary Incontinence / drug therapy*,  economics
Grant Support
799//Multiple Sclerosis Society
Reg. No./Substance:
0/Neuromuscular Agents; EC Toxins, Type A

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