A COST-UTILITY ANALYSIS OF NON-SURGICAL TREATMENTS FOR THE MANAGEMENT OF STRESS URINARY INCONTINENCE IN ADULT WOMEN
GARBENS 1, A. N. SIMPSON2, N. N. BAXTER 1, R. HANCOCK-HOWARD 3, P. C. COYTE 3, C. MCDERMOTT 2;
1Univ. of Toronto/St. Michael's Hosp., Toronto, Canada, 2Obstetrics & Gynaecology, Univ. of Toronto/St. Michael's Hosp., Toronto, Canada, 3Univ. of Toronto, Toronto, Canada.
Introduction: Stress urinary incontinence (SUI) in adult women is common and negatively affects quality of life. While the mid-urethral sling is the gold standard surgical approach, non-surgical treatments are considered first line therapies in SUI treatment. These less invasive treatments have varying efficacies and associated costs. An economic analysis is necessary to aid in patient and physician decision-making.
Objective: The objective of this economic evaluation was to perform a cost-utility analysis (CUA) of non-surgical treatments for SUI in healthy adult women with a health system perspective over a one-year time horizon.
Methods: A decision tree model was constructed to evaluate the following non-surgical treatment options for SUI in a simulated healthy, adult female cohort: (1) Kegel exercises, (2) Pelvic Floor Muscle Therapy (PFMT), (3) A disposable tampon device (Impressa®), (4) A self-fitting intravaginal incontinence device (Uresta®), and (5) a traditional incontinence pessary. Published data and consultation with health care providers were used to estimate treatment costs and efficacies. Health utility estimates were derived from existing literature. A health system perspective was taken with a time horizon of one year. A Monte Carlo probabilistic sensitivity analysis (PSA) was performed to account for the impact of parameter uncertainty on costs and efficacies for each treatment. Alternative analyses were run to confirm our model’s findings. Our primary outcome was the most favourable incremental cost-effectiveness ratio (ICER) at the standard willingness-to-pay (WTP) threshold of $50,000 per quality-adjusted life year (QALY).
Results: The utility of SUI in an otherwise healthy patient was 0.81 + 0.16 (1), and for subjective cure was 0.93 + 0.08 (2). Using base-case estimates with Kegels as the comparator, PFMT was the most cost-effective treatment at an ICER of $36,678/QALY (Table 1). At current market prices, the Impressa® tampon device was not cost-effective and was dominated by all other methods ($81,660/QALY). The Uresta® device and the traditional pessary had ICERs of $6,907/QALY and $1,843/QALY respectively, but were not the preferred methods at the chosen WTP threshold, as they were less effective than PFMT (Figure 1). Alternative analyses confirmed PFMT to be the most cost-effective treatment option at a WTP of $50,000/QALY.
Conclusions: The findings of our economic evaluation favour PFMT as the most cost-effective non-surgical treatment option for SUI at a WTP of $50,000. Improving access to PFMT through public funding may enhance a woman’s quality of life and avoid more invasive treatments.
References: 1. Harvie HS, Shea JA, Andy UU, Propert K, Schwartz JS, Arya LA. Validity of utility measures for women with urge, stress, and mixed urinary incontinence. American journal of obstetrics and gynecology. 2014;210(1):85 e1-6.
2. Mittmann N, Trakas K, Risebrough N, Liu BA. Utility scores for chronic conditions in a community-dwelling population. Pharmacoeconomics. 1999;15(4):369-76.
Table 1. Cost Effectiveness Rankings for One Year of Use
Incremental Cost ($)
ICER=incremental cost-effectiveness ratio (reference: Kegels), C/E= cost effectiveness ratio, QALY=quality-adjusted life year