COST UTILITY ANALYSIS OF BOTOX VS. ANTICHOLINERGIC MEDICATION FOR URINARY INCONTINENCE, DUE TO NEUROGENIC DETRUSOR OVERACTIVITY ASSOCIATED WITH SPINAL CORD INJURY OR MULTIPLE SCLEROSIS
Bibliographic record
Abstract
Introduction Urinary incontinence (UI) negatively impacts quality of life, potentially contributing to depression, urinary tract infection, and renal impairment. Early treatment includes behavioural modification and anticholinergics. Among the general population, ∼40% of patients with overactive bladder do not improve with such treatment. Diapers, pads, and intermittent catheterization may also be used. When earlier options fail, surgery is considered. Botox was approved by Health Canada for UI due to neurogenic detrusor overactivity (NDO), resulting from neurogenic bladder associated with multiple sclerosis or subcervical spinal cord injury in adults who had an inadequate response to or are intolerant of anticholinergic medications. Botox is a sterile form of botulinum neurotoxin type A, derived from the anaerobic bacterium Clostridium botulinum. It is believed to prevent muscle contractions by temporarily blocking nerve impulses to the bladder muscle. Objective To evaluate whether the benefit in urinary incontinence patients with neurogenic detrusor overactivity treated with Botox provides good value for Ontario public funding. Methods A Markov model was used to estimate population outcomes and costs for NDO patients, receiving either Botox or best supportive care (oxybutynin). A Cost Utility Analysis was conducted, using 3 month cycles with a 2 year time horizon (discounted at 5%), plus one-way and probabilistic sensitivity analyses. Results From the incremental cost-effectiveness ratio (ICER) of $9,710/QALY, Botox is more cost-effective compared to oxybutynin. From the cost-effectiveness acceptability curve (CEAC), at a maximum acceptable ceiling ratio of $50,000/QALY, the probability that Botox is cost-effective compared to oxybutynin is 0.987. Conclusion Based on ICER and CEAC, Botox appears to be a cost-effective intervention for urinary incontinence due to neurogenic detrusor overactivity compared with anticholinergic.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.020 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.006 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".