Hamid R, Loveman C, Millen J, Globe D, Corbell C, Colayco D, Stanisic S, Gultyaev D.Cost-Effectiveness Analysis of OnabotulinumtoxinA (BOTOX) for the Management of Urinary Incontinence in Adults with Neurogenic Detrusor Overactivity: A UK Perspective. Pharmacoeconomics. 2014. [Epub ahead of print]
OBJECTIVES:To evaluate the cost effectiveness of 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 anti-cholinergic drugs (ACHDs).
METHODS: A Markov 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.
RESULTS: In 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.
CONCLUSION: For 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.
BoTox is cost-effective for treating bladder problems
CoI: BoToxmay compete against our compound in development