1. Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial.
- Author
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Harvie, Heidi S, Amundsen, Cindy L, Neuwahl, Simon J, Honeycutt, Amanda A, Lukacz, Emily S, Sung, Vivian W, Rogers, Rebecca G, Ellington, David, Ferrando, Cecile A, Chermansky, Christopher J, Mazloomdoost, Donna, and Thomas, Sonia
- Subjects
Reproductive Medicine ,Biomedical and Clinical Sciences ,Health Services ,Clinical Research ,Clinical Trials and Supportive Activities ,Comparative Effectiveness Research ,Urologic Diseases ,Cost Effectiveness Research ,Good Health and Well Being ,Botulinum Toxins ,Type A ,Cost-Benefit Analysis ,Dose-Response Relationship ,Drug ,Female ,Follow-Up Studies ,Health Care Costs ,Humans ,Lumbosacral Plexus ,Male ,Middle Aged ,Prospective Studies ,Time Factors ,Transcutaneous Electric Nerve Stimulation ,Treatment Outcome ,Urinary Incontinence ,Urge ,Urination ,urinary incontinence ,urge ,cost-benefit analysis ,transcutaneous electric nerve stimulation ,botulinum toxins ,type A ,Clinical Sciences ,Urology & Nephrology ,Clinical sciences - Abstract
PurposeSacral neuromodulation and intradetrusor onabotulinumtoxinA injection are therapies for refractory urgency urinary incontinence. Sacral neuromodulation involves surgical implantation of a device that can last 4 to 6 years while onabotulinumtoxinA therapy involves serial office injections. We assessed the cost-effectiveness of 2-stage implantation sacral neuromodulation vs 200 units onabotulinumtoxinA for the treatment of urgency urinary incontinence.Materials and methodsProspective economic evaluation was performed concurrent with the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation vs. BoTulinum Toxin Assessment) randomized trial of 386 women with 6 or more urgency urinary incontinence episodes on a 3-day diary. Analysis is from the health care system perspective with primary within-trial analysis for 2 years and secondary 5-year decision analysis. Costs are in 2018 U.S. dollars. Effectiveness was measured in quality adjusted life-years (QALYs) and reductions in urgency urinary incontinence episodes per day. We generated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.ResultsTwo-year costs were higher for sacral neuromodulation than for onabotulinumtoxinA ($35,680 [95% CI 33,920-37,440] vs $7,460 [95% CI 5,780-9,150], p
- Published
- 2020