Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory neurogenic detrusor overactivity in children
- PMID: 35216926
- DOI: 10.1016/j.jpurol.2022.01.021
Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory neurogenic detrusor overactivity in children
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.
Keywords: Augmentation cystoplasty; Intravesical botulinum toxin type A; Markov model; Neurogenic detrusor overactivity.
Copyright © 2022 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
Comment in
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Commentary on "cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory neurogenic detrusor overactivity in children".J Pediatr Urol. 2022 Jun;18(3):320. doi: 10.1016/j.jpurol.2022.02.021. Epub 2022 Mar 4. J Pediatr Urol. 2022. PMID: 35307339 No abstract available.
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Comment on: "Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory Neurogenic Detrusor Overactivity in Children".J Pediatr Urol. 2022 Jun;18(3):323-324. doi: 10.1016/j.jpurol.2022.02.030. Epub 2022 Mar 23. J Pediatr Urol. 2022. PMID: 35370093 No abstract available.
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