Cost Analysis of Oral Phenazopyridine vs Intravesical Lidocaine for Preprocedural Analgesia for Intradetrusor OnabotulinumtoxinA Injections

No AccessUrology PracticeClinical Research21 Jun 2024Cost Analysis of Oral Phenazopyridine vs Intravesical Lidocaine for Preprocedural Analgesia for Intradetrusor OnabotulinumtoxinA Injections Anjali Kapur, Dora Jericevic, Rui Wang, Lauren Stewart, and Moiuri Siddique Anjali KapurAnjali Kapur Corresponding Author: Anjali Kapur, MD, Department of Urology, NYU Langone Health, New York, New York ([email protected]) , Dora JericevicDora Jericevic Department of Urology, NYU Langone Health, New York, New York , Rui WangRui Wang Princeton Urogynecology, Penn Medicine Princeton Medical Center, Princeton, New Jersey , Lauren StewartLauren Stewart Departments of Obstetrics and Gynecology and Urology, NYU Langone Health, New York, New York , and Moiuri SiddiqueMoiuri Siddique Departments of Obstetrics and Gynecology and Urology, NYU Langone Health, New York, New York View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000628AboutFull TextPDF Cite Export CitationSelect Citation formatNLMIEEEACMAPAChicagoMLAHarvardTips on citation downloadDownload citationCopy citation ToolsAdd to favoritesTrack Citations ShareFacebookLinked InTwitterEmail Abstract Introduction: Office administration of intradetrusor onabotulinumtoxinA is commonly used to treat overactive bladder. For preprocedure analgesia, either 50 mL 2% intravesical lidocaine instillation for 20 to 30 minutes or 200 mg oral phenazopyridine can be used. Phenazopyridine is associated with shorter appointment times and is noninferior to lidocaine for pain control in this setting. We performed a cost analysis of phenazopyridine vs lidocaine for analgesia before office intradetrusor onabotulinumtoxinA injection for the treatment of idiopathic overactive bladder. Methods: A health care sector–perspective cost analysis was performed. The following assumptions were made: (1) similar efficacy of each medication in providing adequate analgesia, (2) similar physician ease of performing the procedure with either analgesic, and (3) similar patient satisfaction with either analgesic. Average cost of medications, adverse reactions, nursing tasks, and office visit time were found in publicly available data. Sensitivity analyses were performed using TreeAge Pro 2021, R1 software. Results: Phenazopyridine is less costly compared to lidocaine per visit for office intradetrusor onabotulinumtoxinA injection ($827 vs $925). A difference of $98 per procedure provides a total annual cost savings of over $24 million if all procedures are performed with phenazopyridine instead of lidocaine. Sensitivity analysis showed that phenazopyridine remained less costly under most circumstances, and threshold analysis provided exact circumstances under which phenazopyridine is no longer cost saving. Conclusions: Phenazopyridine provides cost savings compared to lidocaine for analgesia before office intradetrusor onabotulinumtoxinA injection for the treatment of idiopathic overactive bladder. If adopted by providers nationwide, phenazopyridine may reduce health care spending and minimize office visit time while maintaining patient pain control and satisfaction. References 1. . An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J.2010; 21(1):5-26. doi: 10.1007/s00192-009-0976-9 Crossref, Medline, Google Scholar 2. . Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU Int.2011; 108(7):1132-1138. doi: 10.1111/j.1464-410X.2010.09993.x Crossref, Medline, Google Scholar 3. . Population-based survey of urinary incontinence, overactive bladder, and other lower urinary tract symptoms in five countries: results of the EPIC study. Eur Urol.2006; 50(6):1306-1315; discussion 14-5. doi: 10.1016/j.eururo.2006.09.019 Crossref, Medline, Google Scholar 4. . Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol.2008; 111(3):678-685. doi: 10.1097/AOG.0b013e3181660c1b Crossref, Medline, Google Scholar 5. . Prevalence and burden of overactive bladder in the United States. World J Urol.2003; 20(6):327-336. doi: 10.1007/s00345-002-0301-4 Crossref, Medline, Google Scholar 6. . Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment 2019. J Urol.2019; 202(3):558-563. doi: 10.1097/JU.0000000000000309 Link, Google Scholar 7. . An analysis of factors that influence patient preference of third-line therapy for overactive bladder. Neurourol Urodyn. 2022; 41(8):1906-1913. doi: 10.1002/nau.25046 Crossref, Medline, Google Scholar 8. . Determining patient preferences in the treatment of medication-refractory overactive bladder. Neurourol Urodyn. 2023; 42(2):419-426. doi: 10.1002/nau.25109 Crossref, Medline, Google Scholar 9. . MP19-14 WHO receives third line therapies for overactive bladder? Trends from data in the AUA AQUA registry. J Urol.2023; 209(suppl 4):e270. doi: 10.1097/ju.0000000000003244.14 Link, Google Scholar 10. . Intravesical lidocaine: topical anesthesia for bladder mucosal biopsies. J Urol.1992; 148(3):795-796. doi: 10.1016/s0022-5347(17)36722-8 Link, Google Scholar 11. . Lidocaine as topical anesthesia for bladder mappings and cold-cup biopsies. J Urol.1993; 150(2 Pt 1):335-336. doi: 10.1016/s0022-5347(17)35477-0 Link, Google Scholar 12. . Oral phenazopyridine vs intravesical lidocaine for bladder onabotulinumtoxinA analgesia: a randomized controlled trial. Am J Obstet Gynecol.2022; 227(2):308.e1-308.e8. doi: 10.1016/j.ajog.2022.05.025 Crossref, Medline, Google Scholar 13. . Phenazopyridine associated acute interstitial nephritis and review of literature. Ren Fail.2014; 36(5):804-807. doi: 10.3109/0886022X.2014.890054 Crossref, Medline, Google Scholar 14. . Lidocaine: a local anesthetic, its adverse effects and management. Medicina (Kaunas). 2021; 57(8):782. doi: 10.3390/medicina57080782 Crossref, Medline, Google Scholar 15. . IgE-mediated allergy to local anaesthetics: separating fact from perception: a UK perspective. Br J Anaesth.2012; 108(6):903-911. doi: 10.1093/bja/aes162 Crossref, Medline, Google Scholar 16. . A randomized, prospective, placebo/controlled study for the effect of phenazopyridine HCl on pain perception following cystoscopy. Korean J Urol.2006; 47(1):97. doi: 10.4111/kju.2006.47.1.97 Crossref, Google Scholar 17. . Comparison of the efficacy of oxybutynin, phenazopyridine, celecoxib, and placebo in the treatment of urinary tract symptoms after BCG therapy in patients with bladder tumors. Urol J.2020; 18(4):439-444. doi: 10.22037/uj.v16i7.5947 Crossref, Medline, Google Scholar 18. . Multiple adverse effects of pyridium: a case report. South Med J.2006; 99(1):90-92. doi: 10.1097/01.smj.0000197299.77949.16 Crossref, Medline, Google Scholar 19. . Cost-effectiveness of agents used for evaluation of ureteral patency during intraoperative cystoscopy in gynecologic and urogynecologic surgery. Am J Obstet Gynecol.2022; 226(1):100.e1-100.e6. doi: 10.1016/j.ajog.2021.08.055 Crossref, Medline, Google Scholar 20. National Toxicology Program. Phenazopyridine hydrochloride. Rep Carcinog. 2011; 12:341-342. Medline, Google Scholar 21. . Comparison of times to ureteral efflux after administration of sodium fluorescein and phenazopyridine. J Urol.2017; 197(2):519-523. doi: 10.1016/j.juro.2016.07.099 Link, Google Scholar 22. . Racial and socioeconomic factors influence utilization of advanced therapies in commercially insured OAB patients: an analysis of over 800,000 OAB patients. Urology. 2020; 142:81-86. doi: 10.1016/j.urology.2020.04.109 Crossref, Medline, Google Scholar 23. . The burden of overactive bladder on US public health. Curr Bladder Dysfunct Rep.2016; 11(1):8-13. doi: 10.1007/s11884-016-0344-9 Crossref, Medline, Google Scholar 24. . Lidocaine toxicity secondary to postoperative bladder instillation in a pediatric patient. Urology. 1999; 53(6):1228. doi: 10.1016/s0090-4295(98)00485-3 Crossref, Medline, Google Scholar 25. . Cardiac toxicity after intraurethral instillation of lidocaine: a case report and review of literature. Int Braz J Urol.2020; 46(2):302-305. doi: 10.1590/S1677-5538.IBJU.2019.0259 Crossref, Medline, Google Scholar 26. . Absorption characteristics of lignocaine following intravesical instillation. Scand J Urol Nephrol.1994; 28(4):359-364. doi: 10.3109/00365599409180513 Crossref, Medline, Google Scholar 27. . Interventions to improve tolerability of local anesthetic intradetrusor Botulinum toxin injections: a systematic review. Neurourol Urodyn. 2023; 42(1):23-32. doi: 10.1002/nau.25061 Crossref, Medline, Google Scholar Funding/Support: None. Conflict of Interest Disclosures: The Authors have no conflicts of interest to disclose. Ethics Statement: This study was deemed exempt from Institutional Review Board review. Author Contributions: Conception and design: Kapur, Stewart, Wang. Data analysis and interpretation: Kapur, Jericevic, Stewart, Wang. Drafting the manuscript: Kapur, Jericevic. Critical revision of the manuscript for scientific and factual content: Kapur, Jericevic, Stewart, Siddique, Wang. Statistical analysis: Kapur, Wang. Supervision: Kapur, Stewart, Siddique. Data Availability: The data in this study are available for access upon request. © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Peer Review Report Open Peer Review Report Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Keywordsoveractive bladderonabotulinumtoxinAcost analysishealth care costhealth care servicesMetrics Author Information Anjali Kapur Corresponding Author: Anjali Kapur, MD, Department of Urology, NYU Langone Health, New York, New York ([email protected]) More articles by this author Dora Jericevic Department of Urology, NYU Langone Health, New York, New York More articles by this author Rui Wang Princeton Urogynecology, Penn Medicine Princeton Medical Center, Princeton, New Jersey More articles by this author Lauren Stewart Departments of Obstetrics and Gynecology and Urology, NYU Langone Health, New York, New York More articles by this author Moiuri Siddique Departments of Obstetrics and Gynecology and Urology, NYU Langone Health, New York, New York More articles by this author Expand All Funding/Support: None. Conflict of Interest Disclosures: The Authors have no conflicts of interest to disclose. Ethics Statement: This study was deemed exempt from Institutional Review Board review. Author Contributions: Conception and design: Kapur, Stewart, Wang. Data analysis and interpretation: Kapur, Jericevic, Stewart, Wang. Drafting the manuscript: Kapur, Jericevic. Critical revision of the manuscript for scientific and factual content: Kapur, Jericevic, Stewart, Siddique, Wang. Statistical analysis: Kapur, Wang. Supervision: Kapur, Stewart, Siddique. Data Availability: The data in this study are available for access upon request. Advertisement PDF downloadLoading ...