Component-Level Cost and Variability Drivers of Intradetrusor OnabotulinumtoxinA Injections Across Office and Operating Room Settings
- 1Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- 2Department of Strategic Decision Support, University of Pennsylvania, Philadelphia, Pennsylvania
- 3Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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.
Methods:: 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.
Results:: 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%).
Conclusions:: 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.
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BibTeX
@article{patel2026componentlevel,
title = {{Component-Level Cost and Variability Drivers of Intradetrusor OnabotulinumtoxinA Injections Across Office and Operating Room Settings}},
author = {Saawan D. Patel and Evan Rosario and Robert Stetson and Ariana L. Smith},
journal = {Urology Practice},
year = {2026},
month = sep,
doi = {10.1097/upj.0000000000001067},
url = {https://doi.org/10.1097/upj.0000000000001067},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Component-Level Cost and Variability Drivers of Intradetrusor OnabotulinumtoxinA Injections Across Office and Operating Room Settings
AU - Saawan D. Patel
AU - Evan Rosario
AU - Robert Stetson
AU - Ariana L. Smith
PY - 2026
DA - 2026/09/03
JO - Urology Practice
DO - 10.1097/upj.0000000000001067
UR - https://doi.org/10.1097/upj.0000000000001067
AB - 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. Methods:: 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. Results:: 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%). Conclusions:: 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.
SN - 2352-0779
SN - 2352-0787
ER -