Cost-Effectiveness of Sacral Neuromodulation Compared to Botulinum Neurotoxin A or Continued Medical Management in Refractory Overactive Bladder

Abstract

As a treatment option for refractory idiopathic OAB, at 10 years, SNM provides a considerable possibility of symptom and quality-of-life improvement and is cost-effective compared to BoNT-A or continued OMT.

Bladder ultrasonography for diagnosing detrusor overactivity: test accuracy study and economic evaluation

“…A review of the Cost-Effectiveness Analysis Registry 167 using the terms 'overactive bladder', 'urinary incontinence' and 'detrusor overactivity' was performed to identify relevant utility weights for the outcomes experienced at a time point beyond the primary study end point. Eighteen studies [168][169][170][171][172][173][174][175][176][177][178][179][180][181][182][183][184][185][186] were identified and utility weights from one study 168 were selected to represent the QoL for subjective cure. This study was selected because the utility values were obtained with a sound theoretical approach (time trade-off) and were relevant to the symptoms of OAB and the type of interventions modelled.…”

“…169 Utility weights from other studies were not considered, either because they were focusing on a population with OAB that was undergoing conservative treatments rather than invasive [170][171][172][173][174][175][176] or because they were focusing on women with SUI. [177][178][179][180][181][182] In four more studies, [183][184][185][186] the values of 0.95 and 0.73 were used to represent the utility of continent and incontinent state for a relevant population and interventions, but these were not considered appropriate because the former value in reality represents the utility weight of people with no chronic condition 187 and the latter is based on women with SUI. 188 In the model, women who remain symptomatic were assumed to maintain their initial QoL, which was informed by the primary study.…”

OnabotulinumtoxinA in the treatment of overactive bladder: a cost-effectiveness analysis versus best supportive care in England and Wales

“…The relatively flat curve for the probabilistic analysis around the £20,000 willingness-to-pay threshold indicates a consistent probability of therapy being cost-effective around this threshold. Although there is a previously published economic evaluation of onabotulinumtoxinA 100 U for the treatment of idiopathic OAB [32], this is the first study that incorporates phase 3 data in line with the newly approved indication [33]. The model was based on the pivotal trials of onabotulinumtoxinA in OAB [7,8].…”

“…However, these instruments may produce substantially different values for the same health states, and their ability to discriminate between individuals whose health states are known to differ and to detect a known change in an individual's health state may be limited [34][35][36][37][38]. Deriving a condition-specific preference [15,32]. Utilities were also estimated directly from the condition-specific I-QOL [39] as well as from the SF-12v2 (IUI and SF-6D utilities) [13,14], and evaluated in scenario analysis.…”

Sacral neuromodulation and Botulinum toxin A for refractory idiopathic overactive bladder: a cost-utility analysis in the perspective of Italian Healthcare System

“…When clinical directions are lacking, in order to optimise the use of the limited healthcare budgets available, decision-makers may rely on considerations about the relative costs and effects of alternative therapies or clinical pathways. In Europe, the relative cost-effectiveness of SNM and BoNT/A has been investigated in the Spanish [6], the Dutch [7] and the UK [8] healthcare contexts, providing evidence of the value-for-money of an early adoption of SNM in the care continuum. Nevertheless, to better inform the decision-making process, it appears necessary to verify the transferability of such evidences to other healthcare environments.…”