Cost-Effectiveness Analysis of OnabotulinumtoxinA (BOTOX®) for the Management of Urinary Incontinence in Adults with Neurogenic Detrusor Overactivity: A UK Perspective

Abstract

ObjectivesTo evaluate the cost effectiveness of onabotulinumtoxinA (BOTOX®, 200 units [200 U]) for the management of urinary incontinence (UI) in adults with neurogenic detrusor overactivity (NDO) due to subcervical spinal cord injury or multiple sclerosis that is not adequately managed with anticholinergic drugs (ACHDs).PerspectiveUK National Health Service (NHS) perspective.MethodsA Markov state-transition model was developed, which compared onabotulinumtoxinA + best supportive care (BSC) with BSC alone (comprising behavioural therapy and pads, alone or in combination with clean intermittent catheterization and possibly with ACHDs). Non-responders were eligible for invasive procedures. Health states were defined according to the reduction in UI episodes. Efficacy data and estimates of resource utilization were pooled from 468 patients on onabotulinumtoxinA in two phase III clinical trials. Drug costs (2013) and administration costs (NHS Reference Costs 2011–2012) were obtained from published sources. The time horizon of the model was 5 years, and costs and benefits were discounted at 3.5 %. Scenario, one-way and probabilistic sensitivity analyses (PSAs) were conducted to explore uncertainties around the assumptions.ResultsIn the base case, treatment with onabotulinumtoxinA + BSC over 5 years was associated with an increase in costs of £1,689 and an increase in quality-adjusted life-years (QALYs) of 0.4, compared with BSC alone, resulting in an incremental cost-effectiveness ratio of £3,850 per QALY gained. Sensitivity analyses showed that utility values had the greatest influence on model results. PSA suggests that onabotulinumtoxinA + BSC had a 100 % probability of being cost effective at a willingness to pay of <£20,000.ConclusionFor adult patients with NDO who are not adequately managed with ACHDs, onabotulinumtoxinA + BSC appears to be a cost-effective use of resources in the UK NHS.Electronic supplementary materialThe online version of this article (doi:10.1007/s40273-014-0245-8) contains supplementary material, which is available to authorized users.

Health Care Economic Burden of Treatment and Rehabilitation for Neurogenic Lower Urinary Tract Dysfunction: A Systematic Review

“…Hamid et al reported a total cost of $5,037 for BoNT-A treatment over 5 years, which amounted to $14,483 with addition of best supportive care. 14 The total estimated costs were notably higher in other studies, up to $35,300, likely due to a more comprehensive inclusion of supportive care as well as invasive treatments in estimation of costs accrued during the followup period.…”

“…13 Hamid et al estimated the costs of best supportive care, including a combination of behavioral therapy, incontinence pads, CIC, and the management of adverse events to be $11,683 in the United Kingdom over a 5-year period. 14 In a more recent study, Jaggi et al provided a thorough breakdown of the health care utilization related to neurogenic bladder in the United Kingdom, with a total average annual cost of $3,790. 15 In their study, the largest category of costs was related to hospitalization, with an average cost of $9,901 per year.…”

“…The costs related to BoNT-A treatment were reported in 4 studies (Table 4). 13,14,20,21 The costs per treatment amounted to up to $3,706, of which the costs related to facility reimbursement and medication constituted the largest subcategories. The long-term costs of treatment were estimated in 3 studies, with followups ranging between 3 and 5 years.…”

Clinical Pathways of Third-Line Treatment of Overactive Bladder in the Elderly

“…The cost-effectiveness has been studied between BoNTA with supportive care versus supportive care alone. It confirmed that BoNTA with supportive care is cost effective with 100 % probability [36].…”

The Worldwide Economic Impact of Neurogenic Bladder

“…Although the investigators found no difference in the reduction in incontinence episodes (−1.6 vs. −1.7), there was a significant difference in the number of patients reporting “cure” by the study criteria (27% vs. 13%, respectively, p=0.003). 18 One team of investigators found that onabotulinumtoxinA (BoNT-A) used to treat refractory neurogenic detrusor overactivity from SCI or MS was more effective than “best supportive care” alone, adding 0.4 Quality Adjusted Life years (QALY), at an increased cost of £1,689 over 5 years 19• . The authors felt this was cost effective, but leave the question unanswered regarding how much the system should be willing to pay for one additional QALY.…”