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

OBJECTIVES: To 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 ant...

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Autores principales: Hamid, Rizwan, Loveman, Clara, Millen, Jim, Globe, Denise, Corbell, Catherine, Colayco, Danielle, Stanisic, Sanja, Gultyaev, Dmitry
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381108/
https://www.ncbi.nlm.nih.gov/pubmed/25526842
http://dx.doi.org/10.1007/s40273-014-0245-8
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author Hamid, Rizwan
Loveman, Clara
Millen, Jim
Globe, Denise
Corbell, Catherine
Colayco, Danielle
Stanisic, Sanja
Gultyaev, Dmitry
author_facet Hamid, Rizwan
Loveman, Clara
Millen, Jim
Globe, Denise
Corbell, Catherine
Colayco, Danielle
Stanisic, Sanja
Gultyaev, Dmitry
author_sort Hamid, Rizwan
collection PubMed
description OBJECTIVES: To 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). PERSPECTIVE: UK National Health Service (NHS) perspective. METHODS: A 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. 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40273-014-0245-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-43811082015-04-07 Cost-Effectiveness Analysis of OnabotulinumtoxinA (BOTOX(®)) for the Management of Urinary Incontinence in Adults with Neurogenic Detrusor Overactivity: A UK Perspective Hamid, Rizwan Loveman, Clara Millen, Jim Globe, Denise Corbell, Catherine Colayco, Danielle Stanisic, Sanja Gultyaev, Dmitry Pharmacoeconomics Original Research Article OBJECTIVES: To 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). PERSPECTIVE: UK National Health Service (NHS) perspective. METHODS: A 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. 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s40273-014-0245-8) contains supplementary material, which is available to authorized users. Springer International Publishing 2014-12-20 2015 /pmc/articles/PMC4381108/ /pubmed/25526842 http://dx.doi.org/10.1007/s40273-014-0245-8 Text en © The Author(s) 2014 https://creativecommons.org/licenses/by-nc/4.0/ Open AccessThis article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.
spellingShingle Original Research Article
Hamid, Rizwan
Loveman, Clara
Millen, Jim
Globe, Denise
Corbell, Catherine
Colayco, Danielle
Stanisic, Sanja
Gultyaev, Dmitry
Cost-Effectiveness Analysis of OnabotulinumtoxinA (BOTOX(®)) for the Management of Urinary Incontinence in Adults with Neurogenic Detrusor Overactivity: A UK Perspective
title Cost-Effectiveness Analysis of OnabotulinumtoxinA (BOTOX(®)) for the Management of Urinary Incontinence in Adults with Neurogenic Detrusor Overactivity: A UK Perspective
title_full Cost-Effectiveness Analysis of OnabotulinumtoxinA (BOTOX(®)) for the Management of Urinary Incontinence in Adults with Neurogenic Detrusor Overactivity: A UK Perspective
title_fullStr Cost-Effectiveness Analysis of OnabotulinumtoxinA (BOTOX(®)) for the Management of Urinary Incontinence in Adults with Neurogenic Detrusor Overactivity: A UK Perspective
title_full_unstemmed Cost-Effectiveness Analysis of OnabotulinumtoxinA (BOTOX(®)) for the Management of Urinary Incontinence in Adults with Neurogenic Detrusor Overactivity: A UK Perspective
title_short Cost-Effectiveness Analysis of OnabotulinumtoxinA (BOTOX(®)) for the Management of Urinary Incontinence in Adults with Neurogenic Detrusor Overactivity: A UK Perspective
title_sort cost-effectiveness analysis of onabotulinumtoxina (botox(®)) for the management of urinary incontinence in adults with neurogenic detrusor overactivity: a uk perspective
topic Original Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381108/
https://www.ncbi.nlm.nih.gov/pubmed/25526842
http://dx.doi.org/10.1007/s40273-014-0245-8
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