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Sacral neuromodulation and Botulinum toxin A for refractory idiopathic overactive bladder: a cost-utility analysis in the perspective of Italian Healthcare System

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Abstract

Objectives

To assess the relative cost-effectiveness of two therapeutic strategies: one starting with sacral neuromodulation (SNM) versus one starting with Botulinum toxin A (BTX-A) for the management of refractory incontinent idiopathic overactive bladder (OAB) patients, from the perspective of the Italian National Health Service (INHS).

Methods

Direct medical costs (€2011) and benefits (quality-adjusted life years—QALYs) were assessed over a ten-year time frame adapting to the Italian practice a published Markov model. Clinical inputs were based on the published literature and on the expert opinion. Resource consumption rates were provided by clinical experts; unit costs were collected from a single hospital accounting and from standard tariff lists and public prices. Interventional procedures and management of adverse events were costed through a micro-costing approach. The primary outcome was incremental costs per QALYs gained (i.e. differential costs divided by differential benefits). Deterministic (DSA) and probabilistic (PSA) sensitivity analyses were conducted to assess the robustness of the model.

Results

Starting with SNM appears to be cost effective (i.e. under €40.000/QALY) from year three (€21,259/QALY) onwards and becomes dominant (i.e. more effective and less costly) at year ten: cumulative costs were €32,975 for early SNM and €33,309 for early BTX-A, while cumulative QALYs were 7.52 and 6.93, respectively. At year ten, DSA suggests the results robustness and 99.8 % of the PSA iterations fell within the cost-effectiveness threshold.

Conclusions

A therapeutic strategy starting with SNM may be considered cost effective in the midterm and cost saving in the long-term treatment of idiopathic OAB from the INHS perspective.

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Acknowledgments

The authors thank Medtronic for the permission of adaptation of the model used to perform the study. The economic evaluation was conducted by a Private Company, MSc, Creativ-Ceutical, Milan, Italy, supported by a grant by Medtronic, which never interfered with the evaluation of data and the results of the study. The authors thank Medtronic also for the propriety demonstrated in order to guarantee the intellectual autonomy of the Authors.

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Authors and Affiliations

  1. Neurourology Maria Adelaide Hospital, Azienda Ospedaliera Città della Salute e della Scienza, Turin, Italy

    Maria Paola Bertapelle & Mario Vottero

  2. Neurourology Department, Careggi Hospital, Florence, Italy

    Giulio Del Popolo & Marco Mencarini

  3. Department of Urology, Santa Maria Degli Angeli Hospital, Pordenone, Italy

    Edoardo Ostardo

  4. Neurourology Department, Niguarda Cà Granda Hospital, Milan, Italy

    Michele Spinelli

  5. Department of Urology and Andrology, University of Perugia, Perugia, Italy

    Antonella Giannantoni

  6. Creativ-Ceutical, Milan, Italy

    Anna D’Ausilio

Authors
  1. Maria Paola Bertapelle
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  2. Mario Vottero
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  3. Giulio Del Popolo
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  4. Marco Mencarini
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  5. Edoardo Ostardo
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  6. Michele Spinelli
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  7. Antonella Giannantoni
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  8. Anna D’Ausilio
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Corresponding author

Correspondence to Maria Paola Bertapelle.

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Bertapelle, M.P., Vottero, M., Popolo, G.D. et al. Sacral neuromodulation and Botulinum toxin A for refractory idiopathic overactive bladder: a cost-utility analysis in the perspective of Italian Healthcare System. World J Urol 33, 1109–1117 (2015). https://doi.org/10.1007/s00345-014-1401-7

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  • DOI: https://doi.org/10.1007/s00345-014-1401-7

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