Cost Comparison of Intra-Detrusor Injection of Botulinum Toxin Type A versus Augmentation Cystoplasty for Refractory Neurogenic Detrusor Overactivity in Children
Soo Jeong Kim, MD1, Joseph Babigumira, PhD2, Adam Kern, MD3, Kunj Sheth, MD4, Micah Jacobs, MD5, Ardavan Akhavan, MD1.
1NYP-Weill Cornell, New York, NY, USA, 2University of Washington, Seattle, WA, USA, 3Anne Arundel Urology, Annapolis, MD, USA, 4UT Southwestern, Dallas, TX, USA, 5Children's Health, UT Southwestern, Dallas, TX, USA.
Title: Cost Comparison of Intra-Detrusor Injection of Botulinum Toxin Type A versus Augmentation Cystoplasty for Refractory Neurogenic Detrusor Overactivity in Children
Background: Treatment options for refractory detrusor overactivity among children with neurogenic bladder include botulinum toxin type A and augmentation cystoplasty. Although botulinum toxin type A is accepted in contemporary pediatric urologic practice, cost and long-term outcomes data for botulinum toxin type A are limited relative to the gold standard, augmentation cystoplasty. The purpose of this study was to compare the projected costs of augmentation cystoplasty versus botulinum toxin type A.
Methods: We performed a cost analysis from the payer perspective using a decision tree model. The base case was a pediatric patient with refractory neurogenic DO. Input variables included probabilities derived from published sources, and costs obtained at a tertiary medical center. We assumed biannual botulinum toxin type A treatments. The model was analyzed on an annual basis to ascertain the projected point at which botulinum toxin type A becomes more costly than augmentation cystoplasty. Costs incurred after year one were discounted at 3% per year. The analysis was performed using TreeAge Pro Healthcare 2018 (Williamstown, MA)
Results: The projected cost (net present value (NPV)) of botulinum toxin type A with no complications was $24,906 in year one, rising to $135,646 by year six. The projected annual cost (NPV) of botulinum toxin type A with complications was $72,363 in year one and $392,497 by year six. The lifetime cost of augmentation cystoplasty was $127,898 with no complications and $181,600 with complications. The cost of botulinum toxin type A exceeds the cost augmentation cystoplasty after year six with no complications considered and after year three with complications considered.
Conclusions: Modeling suggests that, if clinically effective for an individual pediatric patient with neurogenic detrusor overactivity, botulinum toxin type A achieves cost equivalence with augmentation cystoplasty between 3 to 6 years.
Figure 1. Decision tree for cost analysis
Figure 2. Estimates of costs and probabilities used in decision tree
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