title: Cost-effectiveness of percutaneous tibial nerve stimulation versus extended release tolterodine for overactive bladder.
abstract: OBJECTIVE
  We assessed the cost-effectiveness of percutaneous tibial nerve stimulation vs extended release tolterodine for the treatment of overactive bladder.
  
  
  METHODS
  A 1-year time frame cost-effectiveness model from a societal perspective was developed by comparing medical costs and quality of life determined by improved continence and therapy side effects of percutaneous tibial nerve stimulation and tolterodine ER. Percutaneous tibial nerve stimulation therapy consisted of 12 sessions for 3 months followed by maintenance therapy. Significant side effects of both strategies can result in reduced quality of life or therapy termination. Parameter estimates included utilities of improved urinary incontinence (0.92) and continued urinary incontinence (0.73), reduction in quality of life from side effects (5%), cost of percutaneous tibial nerve stimulation per session ($203) and cost of tolterodine ER per month ($150). Our primary outcome was the incremental cost-effectiveness ratio, defined as the marginal cost per quality adjusted life-years gained. Less than $50,000 per quality adjusted life-year gained was considered cost-effective. The uncertainty of input parameters was addressed by 1-way sensitivity analyses and Monte Carlo simulation to assess the robustness of the model.
  
  
  RESULTS
  Percutaneous tibial nerve stimulation added significant cost to the management of overactive bladder with modest improvement in quality of life. For every 100 patients treated with percutaneous tibial nerve stimulation the costs increased by $303,480 and resulted in an additional 4.3 quality adjusted life-years gained compared to tolterodine ER. The incremental cost-effectiveness ratio was $70,754 per quality adjusted life-year gained. In the Monte Carlo analysis percutaneous tibial nerve stimulation was cost-effective only 21% of the time.
  
  
  CONCLUSIONS
  Percutaneous tibial nerve stimulation was not cost-effective for treating overactive bladder vs tolterodine ER under a wide range of clinical circumstances.
authors.affiliation: Section of Urogynecology and Pelvic Reconstructive Surgery, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut, USA. heidi1013410134@gmail.com
authors.forename: Heidi W
authors.initials: HW
authors.lastname: Chen
authors.forename: Richard S
authors.initials: RS
authors.lastname: Bercik
authors.forename: Erika F
authors.initials: EF
authors.lastname: Werner
authors.forename: Stephen F
authors.initials: SF
authors.lastname: Thung
mesh_terms: D001559:Benzhydryl Compounds / Q000191:economics* / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003408:Cresols / Q000191:economics* / Q000627:therapeutic use*; D003663:Decision Trees; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D018727:Muscarinic Antagonists / Q000191:economics* / Q000627:therapeutic use*; D010665:Phenylpropanolamine / Q000191:economics* / Q000627:therapeutic use*; D013979:Tibial Nerve; D000068737:Tolterodine Tartrate; D004561:Transcutaneous Electric Nerve Stimulation / Q000191:economics*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000191:economics* / Q000628:therapy*
chemical_list: D001559:Benzhydryl Compounds; D003408:Cresols; D003692:Delayed-Action Preparations; D018727:Muscarinic Antagonists; D010665:Phenylpropanolamine; D000068737:Tolterodine Tartrate