Background and Importance Intradetrusor injections of botulinum toxin type A (TBA) have significantly changed the management of overactive bladder (OAB), allowing the acquisition of urinary continence and control of renal risks. This technique makes it possible to avoid bladder replacement surgery by enterocystoplasty. HAV incurs direct and indirect costs to society.
Aim and Objectives Our study has two main objectives: to evaluate the improvement of the handicap of patients with urinary incontinence by bladder hyperactivity, after injection of botulinum toxin A then to evaluate the cost effectiveness ratio.
Material and Methods A retrospective observational study of 74 patients, who received education on self-catheterisation and treated with TBA at the Urology Department of between January 2018 and August 2022. A model was developed to estimate costs by comparing the cost of TBA versus a standard protocol (involving behaviour al therapy, incontinence pads, anti-cholinergic treatment and, catheters) excluding loss of productivity. A quality of life questionnaire was also administered to patients at the follow-up visits.
Results Profiles of TBA use: Primo-injection in 83.78%.For the indication, AVH without leakage in 32.43%, urinary incontinence by AVH in 35.14%, multiple sclerosis in13, 51%and spinal cord injury in 18.92%. The injections were performed in the operating room. A median paramedical time of30min to prepare the patient and the product. Injection conducted endoscopically lasted a median of8minwith a median hospital stay of 2 days.Clinical improvement in81% with a median duration of efficacy of98days.For adverse events: hypo or a contractile bladder requiring self-catheterisation (n=81%), generalised fatigue (n=40%) and muscle weakness (n=35%).Calculated costs: The cost of an injection is 7000MAD (price produced with the hospital package).The cost of standard treatment without self-catheterisation is 2340MAD (for anticholinergic treatment associated with behavioural therapy). If use of catheters the cost of the injection is8340MAD. If urinary retention occurs, the cost is 13000MAD. Our study shows that the hospital cost is higher than the standard treatment without self-catheterisation and less expensive if catheterisation was previously used, but with a significant improvement in the quality of life according to the questionnaire results.
Conclusion and Relevance For our centre, since 2014, TBA represents a new therapeutic option in second-line treatment.
References and/or Acknowledgements The authors thank all those who contributed to the realisation of this work.
Conflict of Interest No conflict of interest
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.