Cost utility analysis of urethral bulking agents versus midurethral sling in stress urinary incontinence.
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.
From the *Department of Gynecology and Obstetrics, School of Medicine, and †Bloomberg School of Public Health, The Johns Hopkins University; ‡Department of Gynecology, Greater Baltimore Medical Center, Baltimore, MD; §The Ohio State University, Columbus, OH; and ║Alpert Medical School at Brown University, Providence, RI.
Cynelle M
CM
Kunkle
Jennifer L
JL
Hallock
Xiaohan
X
Hu
Joan
J
Blomquist
Stephen F
SF
Thung
Erika F
EF
Werner
D000328:Adult; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D006278:Medicare; D009010:Monte Carlo Method; D011108:Polymers / Q000008:administration & dosage / Q000191:economics; D011183:Postoperative Complications / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D053825:Suburethral Slings / Q000191:economics*; D014481:United States; D014550:Urinary Incontinence, Stress / Q000188:drug therapy / Q000191:economics* / Q000601:surgery
D001672:Biocompatible Materials; D011108:Polymers