Economic evaluation of sacral neuromodulation in overactive bladder: A Canadian perspective

Area of Science:

• Urology
• Health Economics
• Medical Technology Assessment

Background:

• Refractory overactive bladder (OAB) significantly impacts patient quality of life and healthcare costs.
• Many patients do not respond to conservative treatments like optimized medical therapy (OMT).
• Minimally invasive procedures such as sacral neuromodulation (SNM) and botulinum-toxin A (BonT-A) are alternatives for refractory OAB.

Purpose of the Study:

• To estimate the cost-effectiveness of sacral neuromodulation (SNM) compared to botulinum-toxin A (BonT-A) and optimized medical therapy (OMT).
• To provide data for coverage and access decisions regarding OAB therapies.
• To evaluate SNM, BonT-A, and OMT from a provincial payer perspective.

Main Methods:

• A Markov model with Monte Carlo simulation was employed for analysis.
• The study assessed the incremental cost-effectiveness ratio (ICER) over a 10-year time horizon.
• Clinical data, healthcare resource utilization, utility scores, and cost data were sourced from publications, expert panels, and provincial health policies.

Main Results:

• SNM demonstrated incremental quality-adjusted life years compared to both BonT-A and OMT.
• The incremental cost-effectiveness ratio (ICER) for SNM versus BonT-A and OMT fell within acceptable ranges by the second year.
• SNM became the dominant therapy in subsequent years, with a high probability of its ICER remaining below the willingness-to-pay threshold.

Conclusions:

• Sacral neuromodulation (SNM) is a cost-effective treatment for refractory overactive bladder (OAB).
• SNM provides superior long-term outcomes compared to BonT-A and OMT.
• From a Canadian payer perspective, SNM can be considered a first-line therapy for OAB management.