科研之友
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摘要
To determine if Onabotulinumtoxin A (BotoxA (R)) should be offered as a first-line therapy for the treatment of overactive bladder (OAB), even before prescribing anticholinergics.
We performed a cost-effectiveness analysis modeling the following clinical options: no treatment, non-selective anticholinergics, selective anticholinergics, and BotoxA (R). The model timeframe was 2 years to allow BotoxA (R) reinjection and discontinuation of anticholinergics. Multiple efficacy levels included response improvement by < 50%, 50%, 75%, and 100%. BotoxA (R) reinjection was allowed at 6 months if < 50% efficacy. BotoxA (R) complications and anticholinergic side effects were noted. We modeled up to one medication switch. No crossover from BotoxA (R) to anticholinergics or vice versa was allowed, and failures remained with refractory untreated overactive bladder. Medical literature data were used for model parameter values. Costs are 2016 $US.
BotoxA (R) costs more than non-selective anticholinergics and less than selective anticholinergics in models with and without refractory overactive bladder costs. BotoxA (R) had the highest effectiveness (1.763 quality-adjusted life years). Using incremental cost-effectiveness ratios, BotoxA (R) was found to be cost-effective in models with and without refractory costs ($12,428.75 and $14,437.01, respectively). In both models, BotoxA (R) cost less and was more effective than selective anticholinergics, which were "dominated." Over 2 years, subjects averaged 15.6 and 14.3 months on selective and non-selective anticholinergics, respectively, and patients averaged 2.2 BotoxA (R) injections. Model results were unchanged with variation of input parameter estimates in sensitivity analyses.
BotoxA (R) is a cost-effective therapy for overactive bladder and should be further explored as a first-line option in the treatment paradigm.
- 出版日期2018-8
