Commentary on “cost comparison of intra-detrusor injection of botulinum toxin versus augmentation cystoplasty for refractory neurogenic detrusor overactivity in children"

The authors have created a Markov model to evaluate the cost of bridging treatment to augmentation cystoplasty (AC) with bi-annual botulinum toxin type A (BTX-A) versus an initial AC [1]. The model assumes that all patients will eventually require an AC. I'm not certain this is a valid assumption. As the authors mention in the introduction, there is an escalating treatment plan, with initial anticholinergic medication followed by treatment with BTX-A. If all these fail, then there is an escalation to AC.