Cost effectiveness of radiofrequency microremodeling for stress urinary incontinence

Abstract

Introduction and hypothesisStress urinary incontinence (SUI) is a common and growing problem among adult women and affects individuals and society through decreased quality of life (QoL), decreased work productivity, and increased health care costs. A new, nonsurgical treatment option has become available for women who have failed conservative therapy, but its cost effectiveness has not been evaluated. This study examined the cost effectiveness of transurethral radiofrequency microremodeling of the female bladder neck and proximal urethra compared with synthetic transobturator tape (TOT), retropubic transvaginal tape (TVT) sling, and Burch colposuspension surgeries for treating SUI.MethodsA Markov model was used to compare the cost effectiveness of five strategies for treating SUI for patients who had previously failed conservative therapy. The strategies were designed to compare the value of starting with a less invasive treatment. The cost-effectiveness analysis was conducted from the health care system perspective. Efficacy and adverse event rates were obtained from the literature; reimbursement costs were based on Medicare fee schedule. The model cycle was 3 months, with a 3-year time horizon. Single-variable sensitivity analyses were conducted to assess stability of base-case results.ResultsTwo of the five strategies employed the use of transurethral radiofrequency microremodeling and achieved 17–30 % lower mean costs relative to their comparative sling or Burch strategies.ConclusionsSuperior safety and cost effectiveness are recognized when patients are offered a sequential approach to SUI management that employs transurethral radiofrequency microremodeling before invasive surgical procedures. This sequential approach is consistent with treatment strategies for other conditions and offers a solution for women with SUI who want to avoid the inherent risks and costs of invasive continence surgery.

Surgical treatments for women with stress urinary incontinence: a systematic review of economic evidence

“…Seven studies were based in the US [14][15][16][17][18][19][20], six in the UK [21][22][23][24][25][26], six in Canada [27][28][29][30][31][32], two in Spain [33,34], one in Australia [35], one in Bosnia and Herzegovina [36], one in Finland [37], one in Italy [38] and one in the Netherlands [39]. Thirteen studies were model-based analyses [14][15][16][17][18][19][20][21][22][23][27][28][29], seven studies were within-trial evaluations [24-26, 30, 31, 37, 38], five were retrospective data analyses [32,33,35,36,40] and one was prospective non-randomised study [34]. Of the model-based studies, eight studies used a Markov model [14,…”

“…Thirteen studies were model-based analyses [14][15][16][17][18][19][20][21][22][23][27][28][29], seven studies were within-trial evaluations [24-26, 30, 31, 37, 38], five were retrospective data analyses [32,33,35,36,40] and one was prospective non-randomised study [34]. Of the model-based studies, eight studies used a Markov model [14,15,17,19,[21][22][23]27] and five used a decision tree [16,18,20,28,29]. Sixteen studies were CUA [14-17, 19-26, 30, 31, 34, 38], four were CEA [28,29,32,37], four were CCA [18,27,35,40], one was a CMA [33] and one was a CBA [36].…”

“…Of the model-based studies, eight studies used a Markov model [14,15,17,19,[21][22][23]27] and five used a decision tree [16,18,20,28,29]. Sixteen studies were CUA [14-17, 19-26, 30, 31, 34, 38], four were CEA [28,29,32,37], four were CCA [18,27,35,40], one was a CMA [33] and one was a CBA [36]. Fifteen studies reported a health service perspective [17, 19-22, 24-29, 32-34, 38], two studies reported a societal perspective [14,37], one study reported a third-party payer perspective [16], two studies reported a public payer perspective [30,31] and six studies did not report a perspective [15,18,23,35,36,40].…”

“…Fifteen studies reported a health service perspective [17, 19-22, 24-29, 32-34, 38], two studies reported a societal perspective [14,37], one study reported a third-party payer perspective [16], two studies reported a public payer perspective [30,31] and six studies did not report a perspective [15,18,23,35,36,40]. One study reported a lifetime time horizon [14], six studies reported a 10-year time horizon [15, 17-19, 21, 22], nine studies reported a 1-year time horizon [16, 20, 24, 28-30, 33, 34, 37], seven studies reported a 2-5 year time horizon [23,25,27,31,32,38,40] and one study did not report a time horizon [35]. [20,22,28,29], and two studies have included single-incision sling [24,33].…”

“…Costs and consequences were covered from all relevant viewpoints (community or social viewpoint, and those of patients and third-party payers) in only three studies [14,24,37]. All of the included studies measured costs and consequences accurately in appropriate physical units, except for six studies [18,27,33,35,36,40]. All of the included studies valued costs credibly and clearly identified the sources of all values, except for three studies where the sources of unit costs were not clearly identified [29,34,36].…”