Shepherd Jonathan P, Lowder Jerry L, Leng Wendy W, Smith Kenneth J
From the *Division of Urogynecology and Reconstructive Pelvic Surgery, Departments of Obstetrics, Gynecology, and Reproductive Sciences, †Urology, and ‡Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
Female Pelvic Med Reconstr Surg. 2011 Jul;17(4):199-203. doi: 10.1097/SPV.0b013e318224e0d7.
: Overactive bladder is a common disease for which current pharmaceutical therapy is often unsatisfactory. Newer modalities, including Botox and InterStim, can be used when antimuscarinics fail. We compare InterStim and Botox using decision analysis.
: A Markov state transition decision analysis model was constructed using values for efficacy and complications from the literature. Overall utility was compared monthly. Multiple 1-way sensitivity analyses were performed.
: For every month during the simulation, overall utility was higher for Botox than InterStim. After 54 months, cumulative utility was 3.86 versus 3.74, favoring Botox for an average yearly quality-adjusted life-year value of 0.86 versus 0.83. All differences were less than minimally important differences for utilities. Few meaningful thresholds were established supporting the robustness of the model.
: Until appropriately powered randomized controlled trials are available, both InterStim and Botox are reasonable and effective strategies with similar outcomes.
膀胱过度活动症是一种常见疾病，目前的药物治疗往往不尽人意。当抗毒蕈碱药物治疗失败时，可以使用包括肉毒杆菌毒素和骶神经调节（InterStim）在内的更新的治疗方法。我们使用决策分析比较骶神经调节和肉毒杆菌毒素。
利用文献中的疗效和并发症数据构建马尔可夫状态转移决策分析模型。每月比较总体效用。进行了多次单向敏感性分析。
在模拟期间的每个月，肉毒杆菌毒素的总体效用均高于骶神经调节。54个月后，累积效用分别为3.86和3.74，肉毒杆菌毒素更具优势，平均每年质量调整生命年值分别为0.86和0.83。所有差异均小于效用的最小重要差异。建立的有意义阈值很少，这支持了模型的稳健性。
在有足够样本量的随机对照试验可用之前，骶神经调节和肉毒杆菌毒素都是合理且有效的策略，结果相似。
