Cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory neurogenic detrusor overactivity in children. Issue 3 (June 2022)

• Record Type: Journal Article
• Authors: Kim, Soo Jeong; Nang, Quincy G.; RoyChoudhury, Arindam; Kern, Adam J.M.; Sheth, Kunj; Jacobs, Micah; Poppas, Dix Phillip; Akhavan, Ardavan
• Is Part Of: Journal of pediatric urology. Volume 18:Issue 3(2022)
• Page Start: 314
• Page End: 319
• Publication Date: 2022-06
• Subjects: Intravesical botulinum toxin type A -- Augmentation cystoplasty -- Markov model -- Neurogenic detrusor overactivity; Pediatric urology -- Periodicals; Urologic Diseases -- Periodicals; Urogenital Diseases -- Periodicals; Urologic Surgical Procedures -- Periodicals; Child; Infant; Urologie pédiatrique -- Périodiques; Appareil urinaire -- Maladies -- Périodiques; Pédiatrie; Urologie; Pediatric urology; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); Electronic journals; Periodicals; Electronic journals; 618.926
• DOI: 10.1016/j.jpurol.2022.01.021
• Languages: English
• ISSNs: 1477-5131

Abstract

Summary: 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.