title: Cost-effectiveness of sacral neuromodulation compared to botulinum neurotoxin a or continued medical management in refractory overactive bladder.
abstract: OBJECTIVE
  This study assessed the cost-effectiveness and health-care budget impact of sacral neuromodulation (SNM) in refractory idiopathic OAB-wet patients in Spain.
  
  
  METHODS
  A 10-year Markov analytic model was developed to estimate quality-adjusted life-years (QALYs) gained and incontinence episode avoided associated with SNM therapy compared with botulinum neurotoxin A (BoNT-A) or continued optimized medical treatment (OMT).
  
  
  RESULTS
  At 10 years, the cumulative costs of SNM, BoNT-A, and OMT were €29,166, €29,458, and €29,370, respectively, whereas the QALYs for SNM, BoNT-A, and OMT are 6.89, 6.38, and 5.12, respectively. Consequently, incremental cost-effectiveness ratios (ICERs) for SNM demonstrate that although the initial costs for SNM are higher than those for the other treatments, decreasing follow-up costs coupled with consistently greater effectiveness in the long term make SNM the economically dominant option at 10 years. Sensitivity analyses suggest that 99.7% and 99.9% (for SNM vs. BoNT-A and OMT, respectively) of the 1000 Monte Carlo iterations fall within the €30,000 cost-effectiveness threshold, considered to be acceptable in Spain. The 10-year incremental cost per incontinence episode avoided for SNM also makes this therapy the dominant option compared to BoNT-A or OMT. Additionally, the estimated budget impact of the gradually increased referral for SNM for the management of OAB patients in Spain is small.
  
  
  CONCLUSIONS
  As a treatment option for refractory idiopathic OAB, at 10 years, SNM provides a considerable possibility of symptom and quality-of-life improvement and is cost-effective compared to BoNT-A or continued OMT.
authors.affiliation: Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Arlandis
authors.forename: David
authors.initials: D
authors.lastname: Castro
authors.forename: Carlos
authors.initials: C
authors.lastname: Errando
authors.forename: Eldiberto
authors.initials: E
authors.lastname: Fernández
authors.forename: Miguel
authors.initials: M
authors.lastname: Jiménez
authors.forename: Paloma
authors.initials: P
authors.lastname: González
authors.forename: Carlos
authors.initials: C
authors.lastname: Crespo
authors.forename: Funke
authors.initials: F
authors.lastname: Staeuble
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Rodríguez
authors.forename: Max
authors.initials: M
authors.lastname: Brosa
mesh_terms: D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004599:Electric Stimulation Therapy / Q000191:economics*; D005260:Female; D006801:Humans; D008875:Middle Aged; D018377:Neurotransmitter Agents / Q000008:administration & dosage / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012447:Sacrum / Q000294:innervation; D013030:Spain; D001743:Urinary Bladder / Q000294:innervation; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*
chemical_list: D018377:Neurotransmitter Agents; D019274:Botulinum Toxins, Type A