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Study: Anticholinergics versus Botox for Urge Incontinence

November 18, 2013 2 min read

The costs of anticholinergics are similar to the costs of Botox when used as a treatment for urge incontinence for six months, according to results from a randomized trial led by Dr. Anthony G. Visco from the Department of Obstetrics and Gynecology of Duke University Medical Center.

The Anticholinergic versus Botulinum Toxin Comparison (ABC) study was published online in The New England Journal of Medicine. The results were presented at the American Urogynecologic Society (AUGS) 34th Annual Scientific Meeting.

Over the course of two years, Dr. Visco and his colleages aimed to compare the cost effectiveness of anticholinergic medications and Botox on treating moderate-to-severe urgency urinary incontinence (UUI) in women. As recorded in a three-day bladder diary, participants experienced five or more UUI episodes.

The study included 231 women, who were randomly assigned to take daily doses of an oral anticholinergic drug or be given a single 100-U injection of onabotulinumtoxinA (Botox) into the detrusor muscle. The first group started with a solifenacin dose of 5 mg daily. If the dose produced inadequate symptom control after two months, it was increased to 10 mg. If the dose still wasn’t enough after four months, the drug was changed to trospium XR at a dose of 60 mg. To maintain a double blind experience, this group was also given an injection of saline into the detrusor muscle, while the Botox group was given a 6-month oral placebo regimen.

After six months, all oral medications and injections were stopped. The Botox group experienced more urinary tract infections and had to use catheters more than the anticholinergic group. Dry mouth was a common side effect for the drug group. Participants in the Botox group were significantly more likely to report complete resolution of UUI (27% vs. 13%) compared to those in the anticholinergics group. Both groups experienced a reduction of 3.3 urge urinary incontinence episodes per day, and had positive increases in quality-of-life scores.

The researchers examined the direct costs (doctor visits, medication, etc.) and indirect costs (incontinence pad use, laundry, time off work, etc.) of the two treatment options. At six months, the analysis showed that direct medical costs between the Botox and anticholinergic groups ($1339 vs. $1266) were comparable, as were the indirect costs ($150 vs. $106).

After nine months, the cost-effectiveness analysis showed that anticholinergics cost $1942, but Botox cost $1266. This meant that the monthly cost of Botox was significantly lower than the monthly cost of anticholinergic drugs ($207 vs. $30). Symptom control for those who had Botox decreased from 74% to 55% after nine months.

In conclusion, results showed that after six months, the cost of anticholinergics and Botox for the treatment of UUI are similar. However, the costs of anticholinergics increased after nine months. There was no significant difference between the two on the reduction of frequency of UUI episodes or improvements of quality of life.

Source: N Engl J Med 2012; 367:1803-1813 November 8, 2012 DOI: 10.1056/NEJMoa1208872


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