骶神经调节与肉毒杆菌神经毒素 A 或继续药物治疗对难治性膀胱过度活动症的成本效益比较。

Cost-effectiveness of sacral neuromodulation compared to botulinum neurotoxin a or continued medical management in refractory overactive bladder.

机构信息

Hospital Universitario La Fe, Valencia, Spain.

出版信息

Value Health. 2011 Mar-Apr;14(2):219-28. doi: 10.1016/j.jval.2010.08.006.

DOI:10.1016/j.jval.2010.08.006

PMID:21402292

Abstract

OBJECTIVES

This study assessed the cost-effectiveness and health-care budget impact of sacral neuromodulation (SNM) in refractory idiopathic OAB-wet patients in Spain.

METHODS

A 10-year Markov analytic model was developed to estimate quality-adjusted life-years (QALYs) gained and incontinence episode avoided associated with SNM therapy compared with botulinum neurotoxin A (BoNT-A) or continued optimized medical treatment (OMT).

RESULTS

At 10 years, the cumulative costs of SNM, BoNT-A, and OMT were €29,166, €29,458, and €29,370, respectively, whereas the QALYs for SNM, BoNT-A, and OMT are 6.89, 6.38, and 5.12, respectively. Consequently, incremental cost-effectiveness ratios (ICERs) for SNM demonstrate that although the initial costs for SNM are higher than those for the other treatments, decreasing follow-up costs coupled with consistently greater effectiveness in the long term make SNM the economically dominant option at 10 years. Sensitivity analyses suggest that 99.7% and 99.9% (for SNM vs. BoNT-A and OMT, respectively) of the 1000 Monte Carlo iterations fall within the €30,000 cost-effectiveness threshold, considered to be acceptable in Spain. The 10-year incremental cost per incontinence episode avoided for SNM also makes this therapy the dominant option compared to BoNT-A or OMT. Additionally, the estimated budget impact of the gradually increased referral for SNM for the management of OAB patients in Spain is small.

CONCLUSIONS

As a treatment option for refractory idiopathic OAB, at 10 years, SNM provides a considerable possibility of symptom and quality-of-life improvement and is cost-effective compared to BoNT-A or continued OMT.

摘要

目的

本研究评估了骶神经调节（SNM）在西班牙难治性特发性逼尿症伴尿急症（OAB-wet）患者中的成本效益和医疗保健预算影响。

方法

开发了一个 10 年的马尔可夫分析模型，以评估与肉毒杆菌神经毒素 A（BoNT-A）或持续优化的药物治疗（OMT）相比，SNM 治疗带来的质量调整生命年（QALYs）和避免的尿失禁发作。

结果

在 10 年内，SNM、BoNT-A 和 OMT 的累积成本分别为 29166 欧元、29458 欧元和 29370 欧元，而 SNM、BoNT-A 和 OMT 的 QALYs 分别为 6.89、6.38 和 5.12。因此，SNM 的增量成本效益比（ICERs）表明，尽管 SNM 的初始成本高于其他治疗方法，但随着时间的推移，后续成本的降低以及长期内的持续更高的疗效使得 SNM 在 10 年内成为经济上的主导选择。敏感性分析表明，在 1000 次蒙特卡罗迭代中，99.7%（SNM 与 BoNT-A 相比）和 99.9%（SNM 与 OMT 相比）落在西班牙可接受的 30000 欧元成本效益阈值内。与 BoNT-A 或 OMT 相比，SNM 每避免一次尿失禁发作的 10 年增量成本也使该疗法成为主导选择。此外，西班牙逐渐增加 SNM 用于 OAB 患者管理的参考估算的预算影响较小。