Cost-effectiveness of urethral bulking polydimethylsiloxane-Urolastic® compared with mid-urethral sling surgery for stress urinary incontinence: A two-arm cohort study.
BJOG
; 130(6): 674-683, 2023 05.
Article
in En
| MEDLINE
| ID: mdl-36660885
ABSTRACT
OBJECTIVE:
To investigate the cost-effectiveness of urethral bulking polydimethylsiloxane-Urolastic® (PDMS-U) compared with mid-urethral sling (MUS) surgery for stress urinary incontinence (SUI) at 1-year follow-up.DESIGN:
Prospective, two-arm cohort study with 2-year follow-up.SETTING:
International multicentre. POPULATION Women with moderate to severe SUI. MAIN OUTCOMEMEASURES:
Primary outcome was subjective cure (Patient Global Impression of Improvement). SECONDARYOUTCOMES:
objective cure (negative cough stress test), Urogenital Distress Inventory (UDI-6), complications and re-interventions. Cost-effectivenessoutcomes:
total costs, quality-adjusted life year (QALY) using IIQ7-scores (Incontinence Impact Questionnaire) and EQ-5D-5L, incremental cost-effectiveness ratio (ICER) and monetary benefit (adjusted for baseline confounders).RESULTS:
In all, 131 PDMS-U and 153 MUS surgery patients were treated. Subjective cure rates for MUS surgery and PDMS-U were, respectively 101/112 (90%) versus 40/87 (46%), adjusted odds ratio (aOR; for age, body mass index [BMI], severity, type of urinary incontinence and previous SUI procedure) was 4.9. Objective cure rates for MUS surgery and PDMS-U were respectively 98/109 (90%) versus 58/92 (63%), aOR 5.4. Average total costs for PDMS-U and MUS surgery were 3567 and 6688. ICER for MUS surgery cost 15 598 per IIQ QALY and 37 408 per EQ-5D-5L QALY. With a willingness to pay (WTP) of 25 000, MUS has a 84% chance of being cost-effective using IIQ, whereas PDMS-U has a 99% chance of being cost-effective using EQ-5D-5L.CONCLUSION:
MUS surgery is more cost-effective in realising improved disease-specific quality of life (QoL), while PDMS-U is more cost-effective in realising improved generic QoL.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Urinary Incontinence
/
Urinary Incontinence, Stress
/
Suburethral Slings
Type of study:
Etiology_studies
/
Health_economic_evaluation
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Aspects:
Patient_preference
Limits:
Female
/
Humans
Language:
En
Journal:
BJOG
Journal subject:
GINECOLOGIA
/
OBSTETRICIA
Year:
2023
Document type:
Article
Affiliation country:
Países Bajos
Publication country:
ENGLAND
/
ESCOCIA
/
GB
/
GREAT BRITAIN
/
INGLATERRA
/
REINO UNIDO
/
SCOTLAND
/
UK
/
UNITED KINGDOM