Cost-Effectiveness Analysis Between Sacral Neuromodulation and OnabotulinumtoxinA for the Treatment of Refractory Overactive Bladder in Women: A Systematic Review

Abstract

Sacral neuromodulation (SNM) and onabotulinumtoxinA (BONT/A) are well-established treatments for refractory overactive bladder (OAB) syndrome. SNM inhibits urination by stimulating the sacral portion of the spinal court, and BONT/A inhibits acetylcholine by causing detrusor muscle paralysis. Both have been shown to be effective; however, their costeffectiveness is unclear. The aim of this study is to determine which of these treatments-SNM or BONT/A-is more cost-effective in treating OAB.This was a systematic review of the medical literature, using PubMed Medline, EMBASE, Web of Science, Cochrane, and ClinicalTrails.gov, to identify eligible studies. Included were studies that analyzed the cost-effectiveness and cost-utility of SNM versus BONT/A in adult women with nonneurogenic refractory OAB through modeled data or results of randomized controlled trials. Incremental cost-effectiveness ratios (ICERs) were reported as quality-adjusted life years (QALYs).A total of 5 studies were included in this analysis. In 3 studies, ICERs between SNM and BONT/A were reported as primary outcomes; in the other 2 studies, ICERs were calculated based on data. Of the 5 studies, 2 moderate-quality studies favored SNM over BONT/A for cost-effectiveness at the 10-year time horizon (range, $3717/QALY to €15,226/QALY). The remaining 3 studies-all rated as high quality-favored BONT/A versus SNM. Of these 3 studies, one suggested BONT/A would be dominant because SNM was not cost-effective with an ICER of $116,427 at 2 years. Another study favored BONT/