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Cost-effectiveness Analysis: Autologous Rectus Fascial Sling Versus Retropubic Midurethral Sling for Female Stress Urinary Incontinence.
Urogynecology (Phila). 2023 02 01; 29(2):104-112.U

Abstract

IMPORTANCE

There are limited data on the economic comparison between retropubic midurethral sling and autologous fascial sling.

OBJECTIVE

This study aims to evaluate the cost-effectiveness of autologous rectus fascial sling compared with retropubic midurethral sling from both hospital and health care perspectives.

STUDY DESIGN

A decision tree model was developed with 1 year of follow-up. We included variables such as objective success rate, complications and subsequent treatments, and retreatment for incontinence. The model included the index procedure and 1 retreatment for stress urinary incontinence. Cost estimates were calculated from both hospital and health care perspectives. The outcomes were expressed in incremental cost-effectiveness ratio (ICER) or cost per quality-adjusted life-year (QALY). An ICER <$50,000/QALY was considered cost-effective.

RESULTS

From a hospital perspective, the overall cost of retropubic midurethral sling was higher than autologous rectus fascial sling ($2,348.94 vs $2,114.06), but was more effective (0.82 vs 0.80 QALYs). The ICER was $17,452/QALY. From a health care perspective, the overall cost of autologous rectus fascial sling was higher than retropubic midurethral sling ($4,656.63 vs $4,630.47) and was less effective. Retropubic midurethral sling was the dominant strategy, with ICER of -$1,943.32/QALY. If the success rate of autologous rectus fascial sling was ≥84.39%, or the cost of retropubic midurethral sling surgery was > $2,654.36, then autologous rectus fascial sling would become cost-effective.

CONCLUSIONS

Retropubic midurethral sling is the cost-effective treatment from the hospital perspective and the dominant treatment from the health care perspective. However, changes in the costs and success rates of surgical procedures can alter the cost-effectiveness results.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Jia X
From the Division of Female Pelvic Medicine and Reconstructive Surgery, University of Massachusetts Medical School, Worcester, MA.
Wang R
Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT.
Hall C
From the Division of Female Pelvic Medicine and Reconstructive Surgery, University of Massachusetts Medical School, Worcester, MA.
Flynn MK
From the Division of Female Pelvic Medicine and Reconstructive Surgery, University of Massachusetts Medical School, Worcester, MA.

MeSH

FemaleHumansUrinary Incontinence, StressCost-Benefit AnalysisSuburethral SlingsUrinary IncontinenceTreatment Outcome

Pub Type(s)

Journal Article

Language

eng

PubMed ID

36735421

Citation

Jia, Xibei, et al. "Cost-effectiveness Analysis: Autologous Rectus Fascial Sling Versus Retropubic Midurethral Sling for Female Stress Urinary Incontinence." Urogynecology (Philadelphia, Pa.), vol. 29, no. 2, 2023, pp. 104-112.
Jia X, Wang R, Hall C, et al. Cost-effectiveness Analysis: Autologous Rectus Fascial Sling Versus Retropubic Midurethral Sling for Female Stress Urinary Incontinence. Urogynecology (Phila). 2023;29(2):104-112.
Jia, X., Wang, R., Hall, C., & Flynn, M. K. (2023). Cost-effectiveness Analysis: Autologous Rectus Fascial Sling Versus Retropubic Midurethral Sling for Female Stress Urinary Incontinence. Urogynecology (Philadelphia, Pa.), 29(2), 104-112. https://doi.org/10.1097/SPV.0000000000001292
Jia X, et al. Cost-effectiveness Analysis: Autologous Rectus Fascial Sling Versus Retropubic Midurethral Sling for Female Stress Urinary Incontinence. Urogynecology (Phila). 2023 02 1;29(2):104-112. PubMed PMID: 36735421.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cost-effectiveness Analysis: Autologous Rectus Fascial Sling Versus Retropubic Midurethral Sling for Female Stress Urinary Incontinence. AU - Jia,Xibei, AU - Wang,Rui, AU - Hall,Cynthia, AU - Flynn,Michael K, PY - 2023/2/3/entrez PY - 2023/2/4/pubmed PY - 2023/2/8/medline SP - 104 EP - 112 JF - Urogynecology (Philadelphia, Pa.) JO - Urogynecology (Phila) VL - 29 IS - 2 N2 - IMPORTANCE: There are limited data on the economic comparison between retropubic midurethral sling and autologous fascial sling. OBJECTIVE: This study aims to evaluate the cost-effectiveness of autologous rectus fascial sling compared with retropubic midurethral sling from both hospital and health care perspectives. STUDY DESIGN: A decision tree model was developed with 1 year of follow-up. We included variables such as objective success rate, complications and subsequent treatments, and retreatment for incontinence. The model included the index procedure and 1 retreatment for stress urinary incontinence. Cost estimates were calculated from both hospital and health care perspectives. The outcomes were expressed in incremental cost-effectiveness ratio (ICER) or cost per quality-adjusted life-year (QALY). An ICER <$50,000/QALY was considered cost-effective. RESULTS: From a hospital perspective, the overall cost of retropubic midurethral sling was higher than autologous rectus fascial sling ($2,348.94 vs $2,114.06), but was more effective (0.82 vs 0.80 QALYs). The ICER was $17,452/QALY. From a health care perspective, the overall cost of autologous rectus fascial sling was higher than retropubic midurethral sling ($4,656.63 vs $4,630.47) and was less effective. Retropubic midurethral sling was the dominant strategy, with ICER of -$1,943.32/QALY. If the success rate of autologous rectus fascial sling was ≥84.39%, or the cost of retropubic midurethral sling surgery was > $2,654.36, then autologous rectus fascial sling would become cost-effective. CONCLUSIONS: Retropubic midurethral sling is the cost-effective treatment from the hospital perspective and the dominant treatment from the health care perspective. However, changes in the costs and success rates of surgical procedures can alter the cost-effectiveness results. SN - 2771-1897 UR - https://www.unboundmedicine.com/medline/citation/36735421/Cost_effectiveness_Analysis:_Autologous_Rectus_Fascial_Sling_Versus_Retropubic_Midurethral_Sling_for_Female_Stress_Urinary_Incontinence_ DB - PRIME DP - Unbound Medicine ER -