Health Economics Research Centre, University of Oxford, Oxford, UK.
Value Health. 2010 Aug;13(5):565-72. doi: 10.1111/j.1524-4733.2010.00729.x. Epub 2010 Apr 23.
To assess the cost-effectiveness of duloxetine compared with conservative therapy in women with stress urinary incontinence (SUI).
Cost and outcome data were taken from the Stress Urinary Incontinence Treatment (SUIT) study, a 12-month, prospective, observational, naturalistic, multicenter, multicountry study. Costs were assessed in UK pound and outcomes in quality adjusted life years using responses to the EuroQol (EQ-5D); numbers of urine leaks were also estimated. Potential selection bias was countered using multivariate regression and propensity score analysis.
Duloxetine alone, duloxetine in combination with conservative treatment, and conservative treatment alone were associated with roughly two fewer leaks per week compared with no treatment. Duloxetine alone and with conservative treatment for SUI were associated with incremental quality-adjusted life-years (QALYs) of about 0.03 over a year compared with no treatment or with conservative treatment alone. Conservative treatment alone did not show an effect on QALYs. None of the interventions appeared to have marked impacts on costs over a year. Depending on the form of matching, duloxetine either dominated or had an incremental cost-effectiveness ratio (ICER) below pound900 per QALY gained compared with no treatment and with conservative treatment alone. Duloxetine plus conservative therapy had an ICER below pound5500 compared with no treatment or conservative treatment alone. Duloxetine compared with duloxetine plus conservative therapy showed similar outcomes but an additional cost for the combined intervention.
Although the limitations of the use of SUIT's observational data for this purpose need to be acknowledged, the study suggests that initiating duloxetine therapy in SUI is a cost-effective treatment alternative.
评估度洛西汀与保守治疗相比治疗女性压力性尿失禁（SUI）的成本效益。
成本和结果数据来自于一项为期 12 个月的前瞻性、观察性、自然主义、多中心、多国家的 Stress Urinary Incontinence Treatment（SUIT）研究。采用英国英镑评估成本，采用 EuroQol（EQ-5D）的反应评估健康调整生命年（QALY）；还估计了尿液泄漏的次数。使用多元回归和倾向评分分析来对抗潜在的选择偏差。
与不治疗相比，度洛西汀单独使用、度洛西汀联合保守治疗和保守治疗单独使用每周漏尿次数减少约 2 次。与不治疗或单独保守治疗相比，度洛西汀单独治疗和联合保守治疗治疗 SUI 可增加约 0.03 个质量调整生命年（QALY）。单独保守治疗对 QALY 没有影响。在一年内，没有任何干预措施对成本产生明显影响。根据匹配的形式，度洛西汀要么具有优势，要么其增量成本效益比（ICER）低于每获得一个 QALY 英镑 900 以下，与不治疗和单独保守治疗相比。与不治疗或单独保守治疗相比，度洛西汀加保守治疗的 ICER 低于 5500 英镑。与度洛西汀联合保守治疗相比，度洛西汀具有相似的结果，但联合干预的成本更高。
尽管需要承认使用 SUIT 的观察数据进行此目的存在局限性，但该研究表明，在 SUI 中开始度洛西汀治疗是一种具有成本效益的治疗选择。
