Cost-effectiveness of duloxetine: the Stress Urinary Incontinence Treatment (SUIT) study.
OBJECTIVE
To assess the cost-effectiveness of duloxetine compared with conservative therapy in women with stress urinary incontinence (SUI).


METHODS
Cost and outcome data were taken from the Stress Urinary Incontinence Treatment (SUIT) study, a 12-month, prospective, observational, naturalistic, multicenter, multicountry study. Costs were assessed in UK pound and outcomes in quality adjusted life years using responses to the EuroQol (EQ-5D); numbers of urine leaks were also estimated. Potential selection bias was countered using multivariate regression and propensity score analysis.


RESULTS
Duloxetine alone, duloxetine in combination with conservative treatment, and conservative treatment alone were associated with roughly two fewer leaks per week compared with no treatment. Duloxetine alone and with conservative treatment for SUI were associated with incremental quality-adjusted life-years (QALYs) of about 0.03 over a year compared with no treatment or with conservative treatment alone. Conservative treatment alone did not show an effect on QALYs. None of the interventions appeared to have marked impacts on costs over a year. Depending on the form of matching, duloxetine either dominated or had an incremental cost-effectiveness ratio (ICER) below pound900 per QALY gained compared with no treatment and with conservative treatment alone. Duloxetine plus conservative therapy had an ICER below pound5500 compared with no treatment or conservative treatment alone. Duloxetine compared with duloxetine plus conservative therapy showed similar outcomes but an additional cost for the combined intervention.


CONCLUSIONS
Although the limitations of the use of SUIT's observational data for this purpose need to be acknowledged, the study suggests that initiating duloxetine therapy in SUI is a cost-effective treatment alternative.
Mihaylova
Borislava
B
Health Economics Research Centre, University of Oxford, Oxford, UK. boby.mihaylova@dphpc.ox.ac.uk
Pitman
Richard
R
Tincello
Douglas
D
van der Vaart
Huub
H
Tunn
Ralf
R
Timlin
Louise
L
Quail
Deborah
D
Johns
Adam
A
Sculpher
Mark
M
D018759:Adrenergic Uptake Inhibitors / Q000191:economics* / Q000627:therapeutic use; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D000068736:Duloxetine Hydrochloride; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006305:Health Status Indicators; D006801:Humans; D038622:Internationality; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D057216:Propensity Score; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D019057:Quality-Adjusted Life Years; D012044:Regression Analysis; D013876:Thiophenes / Q000191:economics* / Q000627:therapeutic use; D006113:United Kingdom; D014550:Urinary Incontinence, Stress / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D016387:Women's Health
D018759:Adrenergic Uptake Inhibitors; D013876:Thiophenes; D000068736:Duloxetine Hydrochloride