Seklehner Stephan, Laudano Melissa A, Te Alexis E, Kaplan Steven A, Chughtai Bilal, Lee Richard K
Department of Urology, Weill Medical College of Cornell University, New York, New York; Department of Urology, Landesklinikum Baden-Mödling, Baden, Austria.
Neurourol Urodyn. 2014 Nov;33(8):1186-92. doi: 10.1002/nau.22483. Epub 2013 Aug 14.
To compare the cost-effectiveness (CE) of retropubic midurethral sling (RMS) versus transobturator midurethral sling (TMS) for the treatment of female stress urinary incontinence (SUI).
A Markov chain decision model was created to simulate treatment of SUI with RMS versus TMS. Costing data were obtained from the Medicare RBRVS. Data regarding the efficacy and complications associated with RMS versus TMS was compiled from a literature review of 21 randomized RCTs with a minimum of 12 months follow-up, as were corresponding utilities for different continence states. Deterministic and probabilistic estimates of cost-effectiveness (CE) for each procedure were calculated and compared, and sensitivity analyses were performed.
In the base-case deterministic analysis, the efficacy of RMS was 6.275 versus 6.272 QALYs for TMS. QALYs represent a measure of disease burden accounting for both quantity and quality of life lived and are used to assess the monetary value of a medical intervention. The average cost for treatment with RMS however was higher at $9,579 versus $9,017 with TMS. TMS was therefore overall more cost-effective than RMS (CE = $1,438/QALY vs. $1,527/QALY). Sensitivity analysis demonstrated that physician and sling characteristics such as device cost, surgeon fee, efficacy of treatment, operative time, and duration of hospitalization could all affect the relative CE of the therapies.
Our study demonstrated that TMS was more cost-effective than RMS as a treatment for female SUI. The efficacy of the two treatments could be affected by physician and sling characteristic factors.
比较耻骨后尿道中段吊带术（RMS）与经闭孔尿道中段吊带术（TMS）治疗女性压力性尿失禁（SUI）的成本效益（CE）。
建立马尔可夫链决策模型，以模拟用RMS与TMS治疗SUI的情况。成本数据来自医疗保险相对价值标尺更新系统（RBRVS）。关于RMS与TMS相关的疗效和并发症的数据，是从对21项至少随访12个月的随机对照试验（RCT）的文献综述中汇编而来的，不同尿失禁状态的相应效用值也是如此。计算并比较了每种手术的成本效益（CE）的确定性和概率性估计值，并进行了敏感性分析。
在基础案例确定性分析中，RMS的疗效为6.275个质量调整生命年（QALY），而TMS为6.272个QALY。QALY是一种衡量疾病负担的指标，同时考虑了生活的数量和质量，用于评估医疗干预的货币价值。然而，RMS治疗的平均成本更高，为9579美元，而TMS为9017美元。因此，总体而言TMS比RMS更具成本效益（CE = 1438美元/QALY对1527美元/QALY）。敏感性分析表明，医生和吊带的特征，如器械成本、外科医生费用、治疗效果、手术时间和住院时间，都可能影响这些治疗方法的相对成本效益。
我们的研究表明，作为女性SUI的一种治疗方法，TMS比RMS更具成本效益。这两种治疗方法的疗效可能会受到医生和吊带特征因素的影响。
