Cost utility analysis of urethral bulking agents versus midurethral sling in stress urinary incontinence

Cynelle M. Kunkle, Jennifer L. Hallock, Xiaohan Hu, Joan Blomquist, Stephen F. Thung, Erika F. Werner

Research output: Contribution to journalArticle

Abstract

Objective The aim of this study was to determine the cost utility of urethral bulking agents (BA) compared with midurethral slings (MUS) in the treatment of stress urinary incontinence (SUI) in patients without urethral hypermobility. Methods A decision tree was constructed to compare the cost utility of urethral BA versus MUS in the setting of SUI without urethral hypermobility. Probability estimates for success, failure, and complications were obtained from the published literature. Immediate-term, short-term, and longer-term complications were accounted for over a 1-year time horizon in the model. One-way and 2-way sensitivity analyses and Monte Carlo simulations were performed to assess the robustness of our results. Results Our model demonstrated that MUS cost $436,465 more than BA for every 100 women treated in 1 year. Using MUS compared with BA leads to an incremental cost-effectiveness ratio of $70,400 per utility gained. Assuming a willingness to pay of $50,000, this makes MUS not cost-effective as a first-line treatment in many situations. When MUS costs less than $5132, it becomes a cost-effective first-line treatment, and when it costs less than $2035, it is cost saving. Conclusions Bulking agents are more cost-effective than MUS over a 1-year time horizon in the treatment of SUI in patients without urethral hypermobility. In women who lack urethral hypermobility, BA remain a cost-effective option in this patient population.

Original languageEnglish (US)
Pages (from-to)154-159
Number of pages6
JournalFemale Pelvic Medicine and Reconstructive Surgery
Volume21
Issue number3
DOIs
StatePublished - May 9 2015

Keywords

  • bulking agents
  • cost utility
  • midurethral sling
  • stress incontinence
  • urethral hypermobility

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology
  • Urology

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