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Sassani JC, Giugale LE, Lavelle ES, Shepherd JP. Cost-Utility Analysis of Midurethral Sling Timing Among Women Undergoing Prolapse Surgery. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:65-72. [PMID: 37493280 DOI: 10.1097/spv.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
IMPORTANCE There are no guidelines regarding the ideal timing of midurethral sling (MUS) placement following prolapse repair. OBJECTIVE The objective of this study was to estimate the cost-utility of concomitant MUS versus staged MUS among women undergoing apical suspension surgery for pelvic organ prolapse. STUDY DESIGN Cost-utility modeling using a decision analysis tree compared concomitant MUS with staged MUS over a 1-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER). Six scenarios were modeled to estimate cost-utilities for women with preoperative overt, occult, or no stress urinary incontinence (SUI) who underwent either minimally invasive sacrocolpopexy or vaginal native tissue apical suspension. Possible complications of de novo overactive bladder, urinary retention requiring sling lysis, mesh exposure, and persistent SUI were included. Costs from a third-party payer perspective were derived from Medicare 2022 reimbursements. One-way sensitivity analyses were performed. RESULTS Among women without preoperative SUI, staged MUS was the dominant strategy for both surgical routes with higher utility and lower costs. For women with either occult or overt SUI undergoing sacrocolpopexy or vaginal repair, concomitant MUS was cost-effective (ICER = $21,114-$96,536 per quality-adjusted life-year). Therefore, concomitant MUS is preferred for patients with preoperative SUI as higher costs were offset by higher effectiveness. One-way sensitivity analyses demonstrated that ICERs were most affected by probability of cure following MUS. CONCLUSIONS A staged MUS procedure is the dominant strategy for women undergoing apical prolapse repair without preoperative SUI. In women with either overt or occult SUI, the ICER was below the willingness-to-pay threshold of $100,000 per quality-adjusted life-year, suggesting that concomitant MUS surgery is cost-effective.
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Affiliation(s)
| | - Lauren E Giugale
- Division of Urogynecology, Magee-Women's Hospital, University of Pittsburgh, Pittsburgh, PA
| | | | - Jonathan P Shepherd
- Division of Urogynecology, University of Connecticut Health Center, Farmington, CT
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Kutzenberger J, Angermund A, Domurath B, Möhr S, Pretzer J, Soljanik I, Kirschner-Hermanns R. [Short version of the S2k guideline on drug therapy of neurogenic lower urinary tract dysfunction (NLUTD)]. UROLOGIE (HEIDELBERG, GERMANY) 2023; 62:41-52. [PMID: 36271186 DOI: 10.1007/s00120-022-01950-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND In Germany about one million patients suffer from neurogenic lower urinary tract dysfunction (NLUTD). If left untreated, various forms of NLUTD can lead to secondary damage of the lower and upper urinary tract. Thus, the guideline was developed for the drug therapy of patients with NLUTD, who frequently require lifelong care and aftercare. METHODS The guideline was developed in a consensus process with several meetings and online reviews, and final recommendations were decided on in online consensus meetings. Ballots were sent to elected officials of the contributing professional societies. Level of consensus was given for each coordinated recommendation ( https://www.awmf.org/leitlinien/detail/ll/043-053.html ). RESULTS/MOST IMPORTANT RECOMMENDATIONS: (Video)urodynamic classification of the NLUTD should be conducted before the use of antimuscarinic drugs (84.2%). Approved oral antimuscarinics should be used as first choice. Contraindications must be respected (100%). If oral treatment is ineffective or in the case of adverse drug reaction (ADRs) alternatively instillation of oxybutynin solution intravesically (83%) or onabotulinumneurotoxine (OBoNT) injection should be offered (89.5%). In case of failure or ADRs of antimuscarinics, β3 sympathomimetic mirabegron can be used to treat neurogenic detrusor overactivity (NDO) (off-label use) (100%). In case of paraplegia below C8 or multiple sclerosis with an expanded disability status scale (EDSS) of ≤ 6.5, OBoNT injection can be offered as an alternative (89.5%). Drug therapy for NDO should be started early in newborns/young children (84.2%). Conservative, nondrug therapy should be considered in frail elderly (94.7%). No parasympathomimetic therapy should be used to treat neurogenic detrusor underactivity (94.7%). CONCLUSION Precise knowledge of the neurological underlying disease/sequence of trauma and the exact classification of the NLUTD are required for development of individualized therapy.
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Affiliation(s)
- J Kutzenberger
- Departement Neuro-Urologie, Kliniken Hartenstein - UKR, Bad Wildungen, Deutschland.
- , Fontanestr. 16, 34596, Bad Zwesten, Deutschland.
| | - A Angermund
- Neuro-Urologie, Schön Klinik Vogtareuth, Vogtareuth, Deutschland
| | - B Domurath
- Zentrum für Neuro-Urologie, Kliniken Beelitz, Beelitz-Heilstätten, Deutschland
| | - S Möhr
- Neuro-Urologie, REHAB Basel, Klinik für Neurorehabilitation und Paraplegiologie, Basel, Schweiz
| | - J Pretzer
- Klinik für Urologie und Neuro-Urologie, Unfallkrankenhaus Berlin, Berlin, Deutschland
| | - I Soljanik
- Klinik für Paraplegiologie, Department für Orthopädie, Unfallchirurgie und Paraplegiologie, Universität Heidelberg, Heidelberg, Deutschland
| | - R Kirschner-Hermanns
- Universitätsklinikum Bonn, Sektion Neuro-Urologie/, Klinik für Urologie und Kinderurologie und Neuro-Urologie, Johanniter Neurologisches Rehabilitationszentrum Godeshöhe e. V., Bonn, Deutschland
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Ekersund J, Samuelsson E, Lindholm L, Sjöström M. A mobile app for the treatment of female mixed and urgency incontinence: a cost-effectiveness analysis in Sweden. Int Urogynecol J 2022; 33:1273-1282. [PMID: 35278093 PMCID: PMC9119896 DOI: 10.1007/s00192-022-05137-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
Abstract
Abstract
Introduction and hypothesis
A previous randomized controlled trial (RCT) demonstrated that the app Tät II, for self-management of mixed urinary incontinence (MUI) and urgency urinary incontinence (UUI), yielded significant, clinically relevant improvements in symptom severity and quality of life (QoL) compared with a control group. We aimed to assess the cost-effectiveness of Tät II.
Methods
A cost–utility analysis with a 1-year societal perspective was carried out, comparing Tät II with an information app. Data were collected alongside an RCT: 122 community-dwelling women aged ≥18 years with MUI or UUI ≥2 times/week were randomized to 3 months of Tät II treatment focused on pelvic floor muscle training (PFMT) and bladder training (BT; n = 60), or to an information app (n = 62). Self-assessed data from validated questionnaires were collected at baseline and at 3-month and 1-year follow-ups. Costs for assessment, treatment delivery, incontinence aids, laundry, and time for PFMT and BT were included. We calculated quality-adjusted life-years (QALYs) using the International Consultation on Incontinence Modular Questionnaire Lower Urinary Tract Symptoms Quality of Life. The incremental cost-effectiveness ratio (ICER) between the groups was our primary outcome. Sensitivity analyses were performed.
Results
The mean age was 58.3 (SD = 9.6) years. Annual overall costs were €738.42 in the treatment group and €605.82 in the control group; annual QALY gains were 0.0152 and 0.0037 respectively. The base case ICER was €11,770.52; ICERs in the sensitivity analyses ranged from €−9,303.78 to €22,307.67.
Conclusions
The app Tät II is a cost-effective treatment method for women with MUI and UUI.
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Affiliation(s)
- J Ekersund
- Department of Public Health and Clinical Medicine, Umeå University, 905 81, Umeå, Sweden
| | - E Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, 905 81, Umeå, Sweden
| | - L Lindholm
- Department of Public Health and Clinical Medicine, Umeå University, 905 81, Umeå, Sweden
| | - M Sjöström
- Department of Public Health and Clinical Medicine, Umeå University, 905 81, Umeå, Sweden.
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Shabir H, Hashemi S, Al-Rufayie M, Adelowo T, Riaz U, Ullah U, Alam B, Anwar M, de Preux L. Cost-Utility Analysis of Oxybutynin vs. OnabotulinumtoxinA (Botox) in the Treatment of Overactive Bladder Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168743. [PMID: 34444493 PMCID: PMC8394450 DOI: 10.3390/ijerph18168743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 07/31/2021] [Accepted: 08/06/2021] [Indexed: 11/18/2022]
Abstract
Background: The UK National Health Service (NHS) propose the use of oxybutynin prior to onabotulinumtoxinA (Botox) in the management of overactive bladder syndrome (OAB). Oxybutynin is costly and associated with poor adherence, which may not occur with Botox. We conducted a cost-utility analysis (CUA) to compare the medications. Methods: we compared the two treatments in quality-adjusted life years (QALYS), through the NHS’s perspective. Costs were obtained from UK-based sources and were discounted. Total costs were determined by adding the treatment cost and management cost for complications on each branch. A 12-month time frame was used to model the data into a decision tree. Results: Our results found that using Botox first-line had greater cost utility than oxybutynin. The health net benefit calculation showed an increase in 0.22 QALYs when Botox was used first-line. Botox also had greater cost-effectiveness, with the exception of pediatric patients with an ICER of £42,272.14, which is above the NICE threshold of £30,000. Conclusion: Botox was found to be more cost-effective than antimuscarinics in the management of OAB in adults, however less cost-effective in younger patients. This predicates the need for further research to ascertain the age at which Botox becomes cost-effective in the management of OAB.
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Affiliation(s)
- Habiba Shabir
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
- Correspondence: ; Tel.: +44-7506808519
| | - Sana Hashemi
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Moussa Al-Rufayie
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Tayo Adelowo
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Umar Riaz
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Umayair Ullah
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Benyamin Alam
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK;
| | - Mehreen Anwar
- Department of Management and Entrepreneurship, Business School, Imperial College London, London SW7 2BX, UK; (S.H.); (M.A.-R.); (T.A.); (U.R.); (U.U.); (M.A.)
| | - Laure de Preux
- Department of Economics and Public Policy, Business School, Imperial College London, London SW7 2BX, UK;
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Cost Effectiveness of Sacral Neuromodulation and OnabotulinumtoxinA in Managing Refractory Idiopathic Overactive Bladder. Urology 2020; 149:1-10. [PMID: 33227305 DOI: 10.1016/j.urology.2020.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022]
Abstract
Little information from clinical and modelled studies are available on cost effectiveness of OnabotulinumtoxinA and SNM for the treatment of idiopathic overactive bladder. We aimed to summarize the evidence in this regard from different healthcare systems. Seven studies from 5 countries were reviewed. Some modelled studies with a 10-year time frame showed that sacral neuromodulation became dominant long-term; others suggested OnabotulinumtoxinA was more cost effective at <5 years. There was considerable heterogeneity in the base case/sensitivity analysis and statistical modelling among the studies. Clinical studies with longer term follow-up will help determine cost effectiveness more accurately.
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Schimpf MO, Smith AR, Miller JM. Fluids affecting bladder urgency and lower urinary symptoms (FABULUS): methods and protocol for a randomized controlled trial. Int Urogynecol J 2019; 31:1033-1040. [PMID: 31875256 DOI: 10.1007/s00192-019-04209-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/05/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We present the design of a randomized controlled trial, Fluids Affecting Bladder Urgency and Lower Urinary Symptoms (FABULUS), with the purpose of testing the common clinical advice of treating overactive bladder by eliminating potentially irritating beverages (PIBs) that are caffeinated, artificially sweetened, citric, or alcoholic. The primary hypothesis is that women taught to reduce PIBs will show less void frequency compared with a control group instructed in diet/exercise recommendations. Secondary outcomes include change in urgency symptoms and volume per void. METHODS We report the methods for FABULUS and discuss how challenges presented in the literature and from a prior proof-of-concept feasibility trial are addressed by strengthening study design, procedures, and instruments. We introduce the concept of standardized automated tutorials for assisting participants in compliance from study start to finish. The tutorials contain a detailed explanation of the study, including tips for complying with the extensive diary requirements, and parallel tutorials to intervention and control groups for consistency in format and time of instructional content. The intervention tutorial on eliminating PIBs places emphasis on maintaining steady fluid intake volume, as fluctuations have been a confounder in prior work. RESULTS Study results promise to inform about both the tutorial approach and specific PIB reduction for effectively treating overactive bladder. CONCLUSIONS OAB can have a negative impact on quality of life, and current medical treatments carry costs and side-effect risks. If simple lifestyle changes can improve or prevent these bladder symptoms, multiple medical and public health advances could result.
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Affiliation(s)
- Megan O Schimpf
- Department of Obstetrics and Gynecology, Division of Gynecology, University of Michigan, L4000 University Hospital South, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | | | - Janis M Miller
- Department of Obstetrics and Gynecology, Division of Gynecology, University of Michigan, L4000 University Hospital South, 1500 E. Medical Center Dr., Ann Arbor, MI, 48109, USA
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
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Characterizing the Health-Related Quality of Life Burden of Overactive Bladder Using Disease-Specific Patient-Reported Outcome Measures: A Systematic Literature Review. Adv Ther 2019; 36:548-562. [PMID: 30715686 PMCID: PMC6824512 DOI: 10.1007/s12325-019-0880-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Indexed: 01/29/2023]
Abstract
Introduction The objective was to identify the most commonly used patient-reported outcome (PRO) instruments for overactive bladder (OAB), determine which are the most useful for measuring burden in OAB and characterize the findings of recent studies that have employed PRO instruments to assess OAB symptoms and the effects of treatment. Methods A systematic search of OAB literature published between January 2006 and November 2017 using Medline/PubMed and EMBASE databases. Results Of 3425 abstracts and 500 full-text articles reviewed, 58 studies (both clinical trials and observational studies) were included in the review. The most commonly used PRO instruments were the OAB Questionnaire (OAB-q; 64%), followed by the King’s Health Questionnaire (KHQ; 31%) and the Patient Perception of Bladder Condition (PCBC; 21%). Synthesis of data from studies using the OAB-q showed that OAB treatment with antimuscarinics, mirabegron and onabotulinumtoxinA all improve health-related quality of life (HRQoL) and symptoms beyond the benefits observed with placebo. The OAB-q could detect dose–response relationships in some studies and demonstrated there were no significant differences across therapies from different drug classes. Conclusion The HRQoL burden of OAB and response to treatment can be reliably measured by PRO instruments, and the OAB-q is the most commonly used instrument in OAB, particularly in clinical trials of OAB interventions. These data will be useful to provide benchmarks of burden levels for PRO scores obtained among those on contemporary therapies for comparison with outcomes from patients managed with emerging treatments. Funding Astellas Pharma Global Development, Inc. Electronic supplementary material The online version of this article (10.1007/s12325-019-0880-8) contains supplementary material, which is available to authorized users.
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Murray B, Hessami SH, Gultyaev D, Lister J, Dmochowski R, Gillard KK, Stanisic S, Tung A, Boer R, Kaplan S. Cost–effectiveness of overactive bladder treatments: from the US payer perspective. J Comp Eff Res 2019; 8:61-71. [DOI: 10.2217/cer-2018-0079] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To assess the cost–effectiveness of onabotulinumtoxinA (onabotA), implantable sacral nerve stimulation devices, percutaneous tibial nerve stimulation, anticholinergic medications and mirabegron compared with best supportive care (BSC) for management of refractory overactive bladder (OAB). Methods: A Markov model was developed to compare the cost–effectiveness of treatment options with BSC over a 10-year time horizon. Resource utilization, discontinuation rates and costs were derived from unpublished and published sources. Quality-adjusted life-years (QALYs) and incremental cost–effectiveness ratios were reported. Results: Treatment with onabotA 100U produced the largest gain in QALYs (7.179) and lowest estimated incremental cost–effectiveness ratio ($32,680/QALY) of all assessed treatments compared with BSC. Conclusion: Compared with BSC, onabotA 100U was the most cost-effective treatment option for patients with refractory OAB.
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Affiliation(s)
- Brian Murray
- Capital Region Urological Surgeons, 319 S Manning Blvd # 106, Albany, NY, 12208, USA
| | - Sam H Hessami
- Division of Urogynecology and Pelvic Surgery, New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY, 10595, USA
| | - Dmitry Gultyaev
- Analytica LASER, a Certara company, Meeraner Platz 1, 79539, Lörrach, Germany
| | - Johanna Lister
- Analytica LASER, a Certara company, Meeraner Platz 1, 79539, Lörrach, Germany
| | - Roger Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center North, Nashville, TN, 37232, USA
| | | | - Sanja Stanisic
- Analytica LASER, a Certara company, Corso di Porta Nuova 34, 20121, Milano, Italy
| | - Amy Tung
- Allergan plc, 2525 Dupont Drive, Irvine, CA, 92612, USA
| | - Robert Boer
- Allergan plc, 2525 Dupont Drive, Irvine, CA, 92612, USA
| | - Steven Kaplan
- Department of Urology, Mount Sinai Hospital, 625 Madison Avenue, New York, NY, 10022, USA
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A cost-effectiveness analysis of Onabotulinumtoxin A as first-line treatment for overactive bladder. Int Urogynecol J 2018; 29:1213-1219. [DOI: 10.1007/s00192-018-3653-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Accepted: 04/03/2018] [Indexed: 11/26/2022]
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