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

被引:45
作者
Arlandis, Salvador [2 ]
Castro, David [3 ]
Errando, Carlos [4 ]
Fernandez, Eldiberto [5 ]
Jimenez, Miguel [5 ]
Gonzalez, Paloma [6 ]
Crespo, Carlos [7 ,8 ]
Staeuble, Funke [1 ]
Manuel Rodriguez, Jose [6 ]
Brosa, Max [7 ]
机构
[1] Medtron Int Trading Sarl, CH-1131 Tolochenaz, Switzerland
[2] Hosp Univ La Fe, Valencia, Spain
[3] Hosp Clin, Santa Cruz De Tenerife, Spain
[4] Fundacio Puigvert, Barcelona, Spain
[5] Hosp Ramon & Cajal, E-28034 Madrid, Spain
[6] Medtron Iber SA, Madrid, Spain
[7] Oblikue Consulting, Barcelona, Spain
[8] Univ Barcelona, Barcelona, Spain
关键词
Sacral neuromodulation; Refractory overactive bladder; Cost-effectiveness; QALY; Budget impact; URINARY URGE INCONTINENCE; NERVE-STIMULATION; TOXIN-A; EXPERIENCE; DETRUSOR; INJECTIONS; FREQUENCY; IMPACT;
D O I
10.1016/j.jval.2010.08.006
中图分类号
F [经济];
学科分类号
02 ;
摘要
Objectives: This study assessed the cost-effectiveness and health-care budget impact of sacral neuromodulation (SNM) in refractory idiopathic OAB-wet patients in Spain. Methods: A 10-year Markov analytic model was developed to estimate quality-adjusted life-years (QALYs) gained and incontinence episode avoided associated with SNM therapy compared with botulinum neurotoxin A (BoNT-A) or continued optimized medical treatment (OMT). Results: At 10 years, the cumulative costs of SNM, BoNT-A, and OMT were (sic)29,166, (sic)29,458, and (sic)29,370, respectively, whereas the QALYs for SNM, BoNT-A, and OMT are 6.89, 6.38, and 5.12, respectively. Consequently, incremental cost-effectiveness ratios (ICERs) for SNM demonstrate that although the initial costs for SNM are higher than those for the other treatments, decreasing follow-up costs coupled with consistently greater effectiveness in the long term make SNM the economically dominant option at 10 years. Sensitivity analyses suggest that 99.7% and 99.9% (for SNM vs. BoNT-A and OMT, respectively) of the 1000 Monte Carlo iterations fall within the (sic)30,000 cost-effectiveness threshold, considered to be acceptable in Spain. The 10-year incremental cost per incontinence episode avoided for SNM also makes this therapy the dominant option compared to BoNT-A or OMT. Additionally, the estimated budget impact of the gradually increased referral for SNM for the management of OAB patients in Spain is small. Conclusions: 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. Copyright (C) 2011, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.
引用
收藏
页码:219 / 228
页数:10
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