TY - JOUR
T1 - Cost-effectiveness of urethral bulking polydimethylsiloxane-Urolastic (R) compared with mid-urethral sling surgery for stress urinary incontinence: A two-arm cohort study
AU - Casteleijn, F.M.
AU - de Vries, A.M.
AU - Tu, L.M.
AU - Heesakkers, J.P.F.A.
AU - Latul, Y.
AU - Kowalik, C.R.
AU - van Eijndhoven, H.W.F.
AU - van Eekelen, R.
AU - Roovers, J.P.W.R.
N1 - Funding Information:
A non‐restricted research grant from Urogyn BV, the Netherlands was provided. Research grant from ZonMw the Netherlands, Grant number: 80‐84300‐98‐71047.
Publisher Copyright:
© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.
PY - 2023/5
Y1 - 2023/5
N2 - Objective: To investigate the costeffectiveness of urethral bulking polydimethylsiloxaneUrolastic (R) (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 outcome measures: Primary outcome was subjective cure (Patient Global Impression of Improvement). Secondary outcomes: 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 costeffectiveness 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 euro 3567 and euro 6688. ICER for MUS surgery cost euro 15 598 per IIQ QALY and euro 37 408 per EQ- 5D- 5L QALY. With a willingness to pay (WTP) of euro 25 000, MUS has a 84% chance of being costeffective using IIQ, whereas PDMS- U has a 99% chance of being costeffective using EQ-5D-5L.Conclusion: MUS surgery is more costeffective in realising improved disease specific quality of life (QoL), while PDMS- U is more costeffective in realising improved generic QoL.
AB - Objective: To investigate the costeffectiveness of urethral bulking polydimethylsiloxaneUrolastic (R) (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 outcome measures: Primary outcome was subjective cure (Patient Global Impression of Improvement). Secondary outcomes: 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 costeffectiveness 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 euro 3567 and euro 6688. ICER for MUS surgery cost euro 15 598 per IIQ QALY and euro 37 408 per EQ- 5D- 5L QALY. With a willingness to pay (WTP) of euro 25 000, MUS has a 84% chance of being costeffective using IIQ, whereas PDMS- U has a 99% chance of being costeffective using EQ-5D-5L.Conclusion: MUS surgery is more costeffective in realising improved disease specific quality of life (QoL), while PDMS- U is more costeffective in realising improved generic QoL.
KW - cost-effectiveness
KW - mid-urethral sling surgery
KW - stress urinary incontinence
KW - urethral bulking
KW - willingness to pay
KW - AGENTS
U2 - 10.1111/1471-0528.17396
DO - 10.1111/1471-0528.17396
M3 - Article
C2 - 36660885
SN - 1470-0328
VL - 130
SP - 674
EP - 683
JO - Bjog-an International Journal of Obstetrics and Gynaecology
JF - Bjog-an International Journal of Obstetrics and Gynaecology
IS - 6
ER -