Wu Jennifer M, Siddiqui Nazema Y, Amundsen Cindy L, Myers Evan R, Havrilesky Laura J, Visco Anthony G
Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina 27710, USA.
J Urol. 2009 May;181(5):2181-6. doi: 10.1016/j.juro.2009.01.037. Epub 2009 Mar 17.
We assessed the cost-effectiveness of botulinum toxin A injection compared to anticholinergic medications for the treatment of idiopathic urge incontinence.
A Markov decision analysis model was developed to compare the costs in 2008 U. S. dollars and effectiveness in quality adjusted life-years of botulinum toxin A injection and anticholinergic medications. The analysis was conducted from a societal perspective with a 2-year time frame using 3-month cycles. The primary outcome was the incremental cost-effectiveness ratio, defined as the difference in cost (botulinum toxin A cost--anticholinergic cost) divided by the difference in effectiveness (botulinum toxin A quality adjusted life-years--anticholinergic quality adjusted life-years).
While the botulinum strategy was more expensive ($4,392 vs $2,563) it was also more effective (1.63 vs 1.50 quality adjusted life-years) compared to the anticholinergic regimen. The calculated incremental cost-effectiveness ratio was $14,377 per quality adjusted life-year, meaning that botulinum toxin A cost $14,377 per quality adjusted life-year gained. A strategy is often considered cost-effective when the incremental cost-effectiveness ratio is less than $50,000 per quality adjusted life-year. Given this definition botulinum toxin A is cost-effective compared to anticholinergics. To determine if there are situations in which anticholinergics would become cost-effective we performed sensitivity analyses. Anticholinergics become cost-effective if compliance exceeds 75% (33% in the base case) and if the botulinum toxin A procedure cost exceeds $3,875 ($1,690 in the base case). For the remainder of the sensitivity analyses botulinum toxin A remained cost-effective.
Botulinum toxin A injection was cost-effective compared to anticholinergic medications for the treatment of refractory urge incontinence. Anticholinergics become cost-effective if patients are highly compliant with medications or if the botulinum procedure costs increase substantially.
我们评估了A型肉毒杆菌毒素注射与抗胆碱能药物治疗特发性急迫性尿失禁的成本效益。
建立马尔可夫决策分析模型，比较2008年美元成本以及A型肉毒杆菌毒素注射和抗胆碱能药物在质量调整生命年方面的有效性。该分析从社会角度进行，采用2年时间框架，以3个月为周期。主要结果是增量成本效益比，定义为成本差异（A型肉毒杆菌毒素成本 - 抗胆碱能药物成本）除以有效性差异（A型肉毒杆菌毒素质量调整生命年 - 抗胆碱能药物质量调整生命年）。
虽然肉毒杆菌毒素策略成本更高（4392美元对2563美元），但与抗胆碱能治疗方案相比，其效果也更好（1.63对1.50质量调整生命年）。计算得出的增量成本效益比为每质量调整生命年14377美元，这意味着每获得一个质量调整生命年A型肉毒杆菌毒素需花费14377美元。当增量成本效益比低于每质量调整生命年50000美元时，一种策略通常被认为具有成本效益。根据这个定义，与抗胆碱能药物相比，A型肉毒杆菌毒素具有成本效益。为确定是否存在抗胆碱能药物变得具有成本效益的情况，我们进行了敏感性分析。如果依从性超过75%（基础案例中为33%）且A型肉毒杆菌毒素治疗程序成本超过3875美元（基础案例中为1690美元），抗胆碱能药物将变得具有成本效益。在其余敏感性分析中，A型肉毒杆菌毒素仍然具有成本效益。
对于治疗难治性急迫性尿失禁，A型肉毒杆菌毒素注射与抗胆碱能药物相比具有成本效益。如果患者对药物高度依从或A型肉毒杆菌毒素治疗程序成本大幅增加，抗胆碱能药物将变得具有成本效益。
