To investigate the cost-effectiveness of urethral bulking polydimethylsiloxane-Urolastic (PDMS-U) compared to mid-urethral sling (MUS) surgery for stress urinary incontinence (SUI) at one year follow-up.
Prospective, two-arm cohort study with 2 year follow-up SETTING: international multicenter POPULATION: Women with moderate to severe SUI MAIN OUTCOME MEASURES: primary outcome was subjective cure (Patient Global Impression of Improvement).
objective cure (negative cough stress test), Urogenital Distress Inventory (UDI-6), complications and re-interventions. Cost-effectiveness outcomes: 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).
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 OR (for age, 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%), adjusted OR 5.4. Average total costs for PDMS-U and MUS-surgery were €3567 and €6688. ICER for MUS-surgery was €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, while PDMS-U has a 99% chance of being cost-effective using EQ-5D-5L.
MUS-surgery is more cost-effective in realizing improved disease specific QoL, while PDMS-U is more cost-effective in realizing improved generic QoL.
BJOG : an international journal of obstetrics and gynaecology. 2023 Jan 20 [Epub ahead of print]
F M Casteleijn, A M de Vries, L M Tu, J P F A Heesakkers, Y Latul, C R Kowalik, H W F van Eijndhoven, R van Eekelen, J P W R Roovers
Amsterdam UMC, Univ of Amsterdam, Department of Obstetrics and Gynecology, Amsterdam, The Netherlands., Radboud University Medical Centre, Nijmegen, The Netherlands., University of Sherbrooke, Quebec, Canada., Maastricht UMC, Department of Urology, Maastricht, the Netherlands., Isala klinieken, Department of Obstetrics and Gynecology, Zwolle, The Netherlands.