InterStim Sacral Neuromodulation and Botox Botulinum-A Toxin Intradetrusor Injections for Refractory Urge Urinary...

Area of Science:

• Urology
• Decision Analysis
• Health Economics

Background:

• Overactive bladder (OAB) affects many, with current medications often proving insufficient.
• Botulinum toxin (Botox) and sacral neuromodulation (InterStim) are advanced treatments for refractory OAB.

Purpose of the Study:

• To compare the efficacy and utility of Botox versus InterStim for overactive bladder using decision analysis.
• To evaluate long-term outcomes and quality-adjusted life-years (QALYs) for both treatment modalities.

Main Methods:

• A Markov state transition decision analysis model was developed.
• Literature values for efficacy and complication rates were incorporated.
• Monthly overall utility and cumulative utility were compared, with sensitivity analyses performed.

Main Results:

• Botox demonstrated higher monthly overall utility compared to InterStim throughout the simulation.
• After 54 months, cumulative utility favored Botox (3.86 vs. 3.74), translating to higher average yearly QALYs (0.86 vs. 0.83).
• Differences in utility were below minimally important differences, indicating similar clinical significance.

Conclusions:

• Both InterStim and Botox represent effective and reasonable treatment strategies for overactive bladder.
• Further high-powered randomized controlled trials are needed to definitively establish superiority, but current data suggest comparable outcomes.