{
  "abstract": "Introduction:: The purpose of this study was to identify component-level drivers of cost variability for intradetrusor onabotulinumtoxinA (BTX-A) injections for overactive bladder across office-based clinic, tertiary operating room (OR), and hospital outpatient department (HOPD) settings.\n\nMethods:: We performed a retrospective cost analysis of BTX-A injection encounters from January 2020 to June 2025 using institutional activity-based cost accounting data. Costs were grouped into procedural components and categorized as direct or indirect. Mean costs were compared using Welch t tests with Bonferroni correction. Utilization-adjusted variance decomposition identified component-level drivers of cost variability.\n\nResults:: The cohort included 322 tertiary OR, 125 HOPD, and 1492 clinic encounters. Mean total costs were $4633.87 in the tertiary OR, $5063.32 in the HOPD, and $1899.01 in clinic. Total cost variability differed by setting. In the tertiary OR, variability was driven by supplies (29.5%), OR time (25.7%), and postanesthesia recovery (25.5%), while direct cost variability was dominated by supplies (45.1%) and indirect variability by OR time (56.0%). In the HOPD, total cost variability was driven by OR time (41.2%), anesthesia (29.2%), and recovery (16.1%), with similar drivers of indirect variability. In the clinic, total and direct cost variability were driven primarily by cystoscopy (63.9% and 68.7%) and BTX-A (36.1% and 31.3%), while indirect variability was driven by BTX-A (65.4%).\n\nConclusions:: Cost variability differs substantially across procedural settings. Cost-containment efforts should target setting-specific variance drivers rather than mean costs or site of service alone.",
  "abstract_shown": true,
  "affiliations": [
    "Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania",
    "Department of Strategic Decision Support, University of Pennsylvania, Philadelphia, Pennsylvania",
    "Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 4,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Saawan D. Patel",
      "orcid": "0000-0003-3185-7026"
    },
    {
      "affs": [
        0
      ],
      "name": "Evan Rosario"
    },
    {
      "affs": [
        1
      ],
      "name": "Robert Stetson"
    },
    {
      "affs": [
        2
      ],
      "name": "Ariana L. Smith",
      "orcid": "0000-0002-9784-2559"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/fvsf4befayeyf.bib",
  "cited_by": 0,
  "doi": "10.1097/upj.0000000000001067",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13712655/",
  "id": "fvsf4befayeyf",
  "issns": [
    "2352-0779",
    "2352-0787"
  ],
  "landing_url": "https://doi.org/10.1097/upj.0000000000001067",
  "language": "en",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Business"
    ],
    [
      "openalex",
      "2748|Urinary Bladder and Prostate Research"
    ]
  ],
  "openalex": "W7207722212",
  "pdf_url": null,
  "pmcid": "PMC13712655",
  "pmid": "42690216",
  "published": "2026-09-03",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/fvsf4befayeyf.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:23:11Z",
      "native_id": "PMC13712655",
      "source": "pmc",
      "url": "https://doi.org/10.1097/upj.0000000000001067"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2748|Urinary Bladder and Prostate Research",
      "subfield": "general"
    }
  ],
  "title": "Component-Level Cost and Variability Drivers of Intradetrusor OnabotulinumtoxinA Injections Across Office and Operating Room Settings",
  "title_text": "Component-Level Cost and Variability Drivers of Intradetrusor OnabotulinumtoxinA Injections Across Office and Operating Room Settings",
  "type": "peer-reviewed",
  "updated_at": "2026-10-31T12:23:11Z",
  "url": "https://research.draconitic.com/paper/fvsf4befayeyf",
  "venue": "Urology Practice",
  "versions": []
}