Limits...
Cost-effectiveness analysis of onabotulinumtoxinA (BOTOX(®)) for the management of urinary incontinence in adults with neurogenic detrusor overactivity: a UK perspective.

Hamid R, Loveman C, Millen J, Globe D, Corbell C, Colayco D, Stanisic S, Gultyaev D - Pharmacoeconomics (2015)

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: London Spinal Injuries Centre, Stanmore and University College Hospitals, London, UK.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus

Probabilistic sensitivity analysis cost-effectiveness acceptability curve. QALY quality-adjusted life-year
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4381108&req=5

Fig4: Probabilistic sensitivity analysis cost-effectiveness acceptability curve. QALY quality-adjusted life-year

Mentions: One-way sensitivity analyses were applied to the model in order to ascertain the cost effectiveness of onabotulinumtoxinA + BSC. Variations in assumptions regarding costs and outcomes were examined in order to establish the key drivers of the model and to verify the robustness of the primary results. Sensitivity analyses involving health outcomes and cost variables are shown in Fig. 2. Cost effectiveness was sensitive to the utility values used for the health states. As there is no benefit from reduced mortality, all QALY gains result from improvements in HRQoL as a result of fewer weekly UI episodes. The results also indicated that the main drivers of cost in the model are mean CIC and treatment administration costs. PSA indicated that, at a willingness to pay of £20,000 per QALY, onabotulinumtoxinA has a 100 % probability of being cost effective (Figs. 3, 4).Fig. 2


Cost-effectiveness analysis of onabotulinumtoxinA (BOTOX(®)) for the management of urinary incontinence in adults with neurogenic detrusor overactivity: a UK perspective.

Hamid R, Loveman C, Millen J, Globe D, Corbell C, Colayco D, Stanisic S, Gultyaev D - Pharmacoeconomics (2015)

Probabilistic sensitivity analysis cost-effectiveness acceptability curve. QALY quality-adjusted life-year
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4381108&req=5

Fig4: Probabilistic sensitivity analysis cost-effectiveness acceptability curve. QALY quality-adjusted life-year
Mentions: One-way sensitivity analyses were applied to the model in order to ascertain the cost effectiveness of onabotulinumtoxinA + BSC. Variations in assumptions regarding costs and outcomes were examined in order to establish the key drivers of the model and to verify the robustness of the primary results. Sensitivity analyses involving health outcomes and cost variables are shown in Fig. 2. Cost effectiveness was sensitive to the utility values used for the health states. As there is no benefit from reduced mortality, all QALY gains result from improvements in HRQoL as a result of fewer weekly UI episodes. The results also indicated that the main drivers of cost in the model are mean CIC and treatment administration costs. PSA indicated that, at a willingness to pay of £20,000 per QALY, onabotulinumtoxinA has a 100 % probability of being cost effective (Figs. 3, 4).Fig. 2

Bottom Line: 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.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.

View Article: PubMed Central - PubMed

Affiliation: London Spinal Injuries Centre, Stanmore and University College Hospitals, London, UK.

ABSTRACT

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.

No MeSH data available.


Related in: MedlinePlus