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Lookup NU author(s): Dr Mehdi JavanbakhtORCiD, Eoin Moloney, Sheila WallaceORCiD, Professor Laura Ternent, Dr Frauke Becker, Professor Luke ValeORCiD, Professor Dawn CraigORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
Objectives Stress urinary incontinence (SUI) and stress-predominant mixed urinary incontinence (MUI) are common conditions that can have a negative impact on the quality of life of patients and serious cost implications for healthcare providers. The objective of this study was to assess the cost-effectiveness of nine different surgical interventions for treatment of SUI and stress-predominant MUI from a National Health Service and personal social services perspective in the UK.Methods A Markov microsimulation model was developed to compare the costs and effectiveness of nine surgical interventions. The model was informed by undertaking a systematic review of clinical effectiveness and network meta-analysis. The main clinical parameters in the model were the cure and incidence rates of complications after different interventions. The outcomes from the model were expressed in terms of cost per quality-adjusted life-years (QALYs) gained. In addition, expected value of perfect information (EVPI) analyses were conducted to quantify the main uncertainties facing decision-makers.Results The base-case results suggest that retropubic mid-urethral sling (retro-MUS) is the most cost-effective surgical intervention over a 10-year and lifetime time horizon. The probabilistic results show that retro-MUS and traditional sling are the interventions with the highest probability of being cost-effective across all willingness-to-pay thresholds over a lifetime time horizon. The value of information analysis results suggest that the largest value appears to be in removing uncertainty around the incidence rates of complications, the relative treatment effectiveness and health utility values.Conclusions Although retro-MUS appears, at this stage, to be a cost-effective intervention, research is needed on possible long-term complications of all surgical treatments to provide reassurance of safety, or earlier warning of unanticipated adverse effects. The value of information analysis supports the need, as a first step, for further research to improve our knowledge of the actual incidence of complications.
Author(s): Javanbakht M, Moloney E, Brazzelli M, Wallace S, Ternent L, Omar MI, Monga A, Saraswat L, Mackie P, Becker F, Imamura M, Hudson J, Shimonovich M, MacLennan G, Vale L, Craig D
Publication type: Article
Publication status: Published
Journal: BMJ Open
Year: 2020
Volume: 10
Issue: 6
Online publication date: 11/06/2020
Acceptance date: 05/05/2020
Date deposited: 12/06/2020
ISSN (electronic): 2044-6055
Publisher: BMJ Publishing Group Ltd
URL: http://dx.doi.org/10.1136/bmjopen-2019-035555
DOI: 10.1136/bmjopen-2019-035555
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