Cost Utility Analysis of Urethral Bulking Agents Versus Midurethral Sling in Stress Urinary Incontinence

Kunkle, Cynelle M.; Hallock, Jennifer L.; Hu, Xiheng; Blomquist, Joan L.; Thung, Stephen; Werner, Erika F.

doi:10.1097/spv.0000000000000173

Cited by 33 publications

(16 citation statements)

References 42 publications

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“…Seven studies were based in the US [14][15][16][17][18][19][20], six in the UK [21][22][23][24][25][26], six in Canada [27][28][29][30][31][32], two in Spain [33,34], one in Australia [35], one in Bosnia and Herzegovina [36], one in Finland [37], one in Italy [38] and one in the Netherlands [39]. Thirteen studies were model-based analyses [14][15][16][17][18][19][20][21][22][23][27][28][29], seven studies were within-trial evaluations [24-26, 30, 31, 37, 38], five were retrospective data analyses [32,33,35,36,40] and one was prospective non-randomised study [34]. Of the model-based studies, eight studies used a Markov model [14,…”

Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

“…Thirteen studies were model-based analyses [14][15][16][17][18][19][20][21][22][23][27][28][29], seven studies were within-trial evaluations [24-26, 30, 31, 37, 38], five were retrospective data analyses [32,33,35,36,40] and one was prospective non-randomised study [34]. Of the model-based studies, eight studies used a Markov model [14,15,17,19,[21][22][23]27] and five used a decision tree [16,18,20,28,29]. Sixteen studies were CUA [14-17, 19-26, 30, 31, 34, 38], four were CEA [28,29,32,37], four were CCA [18,27,35,40], one was a CMA [33] and one was a CBA [36].…”

Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

“…One study reported a lifetime time horizon [14], six studies reported a 10-year time horizon [15, 17-19, 21, 22], nine studies reported a 1-year time horizon [16, 20, 24, 28-30, 33, 34, 37], seven studies reported a 2-5 year time horizon [23,25,27,31,32,38,40] and one study did not report a time horizon [35]. [20,22,28,29], and two studies have included single-incision sling [24,33]. Other evaluated surgeries were trad-sling, bladder neck needle, and vaginoplasty by Kelly.…”

Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

“…Of the studies that did establish effectiveness, ten determined effectiveness through a randomised controlled clinical trial [16, 23-26, 29-31, 37, 38] and nine studies established effectiveness through an overview of clinical studies [14, 15, 17-19, 21, 22, 27, 28]. Seven studies used observational data or assumptions to establish effectiveness [20,[32][33][34][35][36]40]. Most of the included studies identified the important and relevant costs and consequences of the alternatives being compared, except for seven studies [14,16,32,33,35,36,40].…”

Section: Quality Assessmentmentioning

confidence: 99%

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Surgical treatments for women with stress urinary incontinence: a systematic review of economic evidence

et al. 2020

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Background: Surgical interventions for the treatment of stress urinary incontinence (SUI) in women are commonly employed following the failure of minimally invasive therapies. Due to the limited information available on the relative cost-effectiveness of available surgeries for treating SUI, a de novo economic analysis was conducted to assess costs and effects of all relevant surgeries. To inform the economic analysis, the objective of this review was to identify and assess the quality of existing economic evaluation studies on different surgical interventions for the treatment of SUI in women. Methods: The following databases were searched during the review process: Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process, Excerpta Medica Database (Embase), National Health Service Economic Evaluation Database (NHS EED), and Health Management Information Consortium and Cost-Effectiveness Analysis Registry (CEA registry). The key criteria for inclusion were that the study population included women with SUI and that the surgical interventions considered were utilised as either a primary or a follow-up surgery. The review included only full economic evaluations. Studies were quality assessed using the Drummond checklist for economic evaluations. No quantitative synthesis of the results by meta-analysis was conducted due to the high methodological heterogeneity. Results: Twenty-six economic evaluations were included, of which 13 were model-based analyses. Surgical treatments assessed most frequently were mid-urethral slings and open and laparoscopic colposuspension. There were some differences in the methodological approaches taken, including differences in type of economic analysis, perspective, time horizon, types of resource use, and costs and outcomes that were included in the analysis. The majority of studies conducted a cost-utility analysis from a health system perspective and applied a time horizon of between 1 and 5 years. The cost-effectiveness results suggest that single-incision mini-sling and mid-urethral slings are among the most cost-effective options.

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Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Basic Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Quality Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Surgical treatments for women with stress urinary incontinence: a systematic review of economic evidence

et al. 2020

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“…Evidence for the cost‐effectiveness of bulking agents is also inconsistent, showing cost‐effectiveness in the short term only. When compared with mid‐urethral slings, some evidence suggests bulking agents may be more cost‐effective as a first‐line treatment at short‐term follow‐up or following failed initial surgical treatment . However, other evidence suggests bulking agents are less effective than traditional sling procedures as a first‐line therapy when followed up in the longer term .…”

Section: Treatment Of Stress Urinary Incontinencementioning

confidence: 99%

The use of urethral bulking agents in the treatment of stress urinary incontinence

McGowan

Campbell

Dolan

2020

The Obstetric & Gynaecologis

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Key content Treatment options for stress urinary incontinence (SUI) include physical therapies and a range of surgical options. Urethral bulking agents may be used as a surgical treatment for SUI. There are different types of bulking agents, with varying complications and outcomes. We discuss the impact of the current UK pause for vigilance and restriction on the use of mesh in the treatment of SUI. Learning objectives To gain an overview of the history of bulking agents. To understand the properties of commonly used bulking agents. To understand the clinical indications and evidence on efficacy and complications of urethral bulking agents. Ethical considerations Should urethral bulking agents be used as a first‐line treatment for SUI? Should the introduction of new urethral bulking agents be undertaken within a clinical research trial in light of lessons learned from the introduction of vaginal mesh implants? Women with SUI should be counselled on both surgical and nonsurgical options. There is an absence of long‐term safety and outcome data for newer bulking agents.

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Traditional suburethral sling operations for urinary incontinence in women

Rehman

Bezerra²,

Bruschini

et al. 2017

Cochrane Database of Systematic Reviews

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Cost Utility Analysis of Urethral Bulking Agents Versus Midurethral Sling in Stress Urinary Incontinence

Abstract: 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.

Cited by 33 publications

References 42 publications

Surgical treatments for women with stress urinary incontinence: a systematic review of economic evidence

Surgical treatments for women with stress urinary incontinence: a systematic review of economic evidence

The use of urethral bulking agents in the treatment of stress urinary incontinence

Traditional suburethral sling operations for urinary incontinence in women

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