Clinical Resource Use in Patients Undergoing Intradetrusor Abotulinum Toxin A Injections for Neurogenic Compared to...

Intradetrusor abotulinum toxin A (BoNT-A) injections effectively manage urinary urgency, frequency, and urinary incontinence in patients with both overactive bladder (OAB) and neurogenic lower urinary tract dysfunction (NLUTD). However, NLUTD patients often require increased staffing support and extended procedure times compared to OAB patients. This study aims to quantify resource utilization differences between the two populations undergoing cystoscopic BoNT-A treatment where only one Current Procedural Terminology Code (CPT 52287) exists.

We prospectively collected data at a tertiary urology clinic over 6 months on patients undergoing cystoscopic intradetrusor BoNT-A injection. Nursing/medical assistant (RN/MA) time, physician time, room occupancy duration, and staffing numbers were documented.

Sixty-five patients (NLUTD = 44 and OAB = 21) were included. NLUTD patients when compared to OAB patients required significantly greater RN/MA time (72 min vs. 48 min, p < 0.001), extended room occupancy (51 min vs. 43 min, p = 0.013), and RN/MA staff per procedure (2.4 vs. 1.9 RN/MA's, p < 0.001). Physician times, while statistically different, were clinically similar (9 min vs 7 min, p = 0.008).

When comparing a NLUTD to an OAB population undergoing intradetrusor BoNT-A injections, current procedural billing codes do not reflect the substantial differences in auxiliary staff requirements or room occupancy times. The absence of nuanced reimbursement mechanisms may foster avoidance of resource-intensive patient populations and their medical access. Our findings underscore the potential need to consider implementing novel reimbursement strategies to ensure equitable access to care.