Intravesical Botulinum Toxin for Adults with Non-Neurogenic Bladder Conditions: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines

Key Message

Data from four SRs and three RCTs with relatively high quality found that intravesical onabotulinumtoxinA (onabotA) improved overactive bladder (OAB) and bladder pain syndrome/interstitial cystitis (BPS/IC) symptoms compared to placebo (direct comparison) or various anticholinergics (indirect network analyses). Compared to placebo, onabotA may lead to more frequent adverse events such as urinary tract infection and urinary retention in patients with OAB, but not in patients with BPS/IS. A cost study conducted in the US found that onabotA 100U and anticholinergic medication have similar costs and effectiveness after six months of treatment for OAB. Two cost studies conducted in Europe with time-horizon up to 10 years found that onabotA 100U is more cost-effective than best supportive care alone for OAB. The Canadian Urological Association and American Urological Association provide recommendations or non-directive statements for the use of onabotA 100U in patients with OAB as a third-line therapy to patients refractory to conservative treatment and pharmacotherapy (based on moderate to strong strength of evidence), and the use of onabotA 100U in patients with BPS/IC refractory to other treatments (based on weak strength of evidence). No evidence on the comparative effectiveness of botulinum toxin for the treatment of DOA and on the cost effectiveness for DOA and BPS/IC was identified.