288 COST-EFFECTIVENESS OF SACRAL NEUROMODULATION IN REFRACTORY OVERACTIVE BLADDER A CANADIAN PERSPECTIVE (2012)

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2012288 COST-EFFECTIVENESS OF SACRAL NEUROMODULATION IN REFRACTORY OVERACTIVE BLADDER A CANADIAN PERSPECTIVE Magdy Hassouna, Jacques Corcos, Neil Dwyer, Jerzy Gajewski, gary Gray, Magali Robert, Le-mai Tu, and Hamid Sadri Magdy HassounaMagdy Hassouna Toronto, Canada More articles by this author , Jacques CorcosJacques Corcos Montreal, Canada More articles by this author , Neil DwyerNeil Dwyer Moncton, Canada More articles by this author , Jerzy GajewskiJerzy Gajewski Dalhousie, Canada More articles by this author , gary Graygary Gray Calgary, Canada More articles by this author , Magali RobertMagali Robert Calgary, Canada More articles by this author , Le-mai TuLe-mai Tu Sherbrooke, Canada More articles by this author , and Hamid SadriHamid Sadri Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.346AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Refractory overactive bladder (OAB) with urgency incontinence is an underdiagnosed condition with substantial burden on the healthcare system and diminished patient's quality of life. A significant number of patients will fail conservative treatment with optimized medical therapy (OMT) and may benefit from minimally invasive procedures including sacral neuromodulation (SNM) or botulinum toxin (BonT-A) injection. The goal of this study was to estimate the cost-effectiveness of SNM vs. OMT and BonT-A. METHODS An economic Markov model with Monte Carlo simulation was used to assess the incremental cost-effectiveness ratio (ICER) of SNM vs. BonT-A and OMT. The model calculated the ICER in deterministic (base-case) and probabilistic (sensitivity) analysis from a Canadian provincial payer's perspective over a 10-year time horizon with 9-month Markov cycles. Clinical data, healthcare resource utilization and utility scores were acquired from recent publications and an expert panel of 7 Canadian surgeons. Cost data (2011-Dollars) were derived from provincial health insurance policy, drug benefit formulary, and hospital data. All cost and outcomes were discounted at 3% rate. RESULTS The annual (year 1-10) incremental Quality-Adjusted Life Years (QALY) for SNM vs. BonT-A was 0.05-0.51 and SNM vs. OMT was 0.19-1.76. The annual incremental cost of SNM vs. BonT-A was $7,237 in year-1 and -$9,402 in year-10 and was between $8,878 to -$11,447 vs. OMT. In the base-case deterministic analysis, the ICER for SNM vs. BonT-A and OMT were within the acceptable range ($44,837 and $15,130 respectively) at the second year of treatment, with SNM being dominant in the consequent years. In the base-case analysis the probability of ICER being below the acceptability curve (Willingness-To-Pay = $50,000) in Canada was >99% for SNM vs. BonT-A at year 3 and >95% for OMT at year 2. CONCLUSIONS Sacral neuromodulation is a cost-effective treatment option for the management of patients with refractory overactive bladder when compared to either botolinum toxin or optimal medical therapy. From a Canadian payers' perspective, sacral neuromodulation should be considered as first line treatment option in patients with overactive bladder. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e117 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Magdy Hassouna Toronto, Canada More articles by this author Jacques Corcos Montreal, Canada More articles by this author Neil Dwyer Moncton, Canada More articles by this author Jerzy Gajewski Dalhousie, Canada More articles by this author gary Gray Calgary, Canada More articles by this author Magali Robert Calgary, Canada More articles by this author Le-mai Tu Sherbrooke, Canada More articles by this author Hamid Sadri Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...