Cost-effectiveness Analysis: Autologous Rectus Fascial Sling Versus Retropubic Midurethral Sling for Female Stress Urinary Incontinence. Issue 2 (February 2023)

• Record Type: Journal Article
• Authors: Jia, Xibei; Wang, Rui; Hall, Cynthia; Flynn, Michael K.
• Is Part Of: Urogynecology. Volume 29:Issue 2(2023)
• Page Start: 104
• Page End: 112
• Publication Date: 2023-02
• Subjects: Pelvis -- Diseases; Pelvis -- Surgery; Urogynecology; Urogynecologic surgery; 616.6
• DOI: 10.1097/SPV.0000000000001292
• Languages: English
• ISSNs: 2771-1897

Abstract

Abstract : Importance: There are limited data on the economic comparison between retropubic midurethral sling and autologous fascial sling. Objective: This study aims to evaluate the cost-effectiveness of autologous rectus fascial sling compared with retropubic midurethral sling from both hospital and health care perspectives. Study Design: A decision tree model was developed with 1 year of follow-up. We included variables such as objective success rate, complications and subsequent treatments, and retreatment for incontinence. The model included the index procedure and 1 retreatment for stress urinary incontinence. Cost estimates were calculated from both hospital and health care perspectives. The outcomes were expressed in incremental cost-effectiveness ratio (ICER) or cost per quality-adjusted life-year (QALY). An ICER <$50, 000/QALY was considered cost-effective. Results: From a hospital perspective, the overall cost of retropubic midurethral sling was higher than autologous rectus fascial sling ($2, 348.94 vs $2, 114.06), but was more effective (0.82 vs 0.80 QALYs). The ICER was $17, 452/QALY. From a health care perspective, the overall cost of autologous rectus fascial sling was higher than retropubic midurethral sling ($4, 656.63 vs $4, 630.47) and was less effective. Retropubic midurethral sling was the dominant strategy, with ICER of −$1, 943.32/QALY. If the success rate of autologous rectus fascial sling was ≥84.39%, or the cost of retropubic midurethral sling surgery was > $2, 654.36, then autologous rectus fascial sling would become cost-effective. Conclusions: Retropubic midurethral sling is the cost-effective treatment from the hospital perspective and the dominant treatment from the health care perspective. However, changes in the costs and success rates of surgical procedures can alter the cost-effectiveness results.