Published in:
01-09-2018 | Overactive Bladder and Lower Urinary Tract Symptoms (U Lee and S Adelstein, Section Editors)
Cost-Effectiveness of Third-Line Therapies for Overactive Bladder
Published in: Current Bladder Dysfunction Reports | Issue 3/2018
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Purpose of Review
While third-line therapies for overactive bladder and urgency urinary incontinence are well-described in guideline statements, there is little offered in guidance when it comes to selecting a particular intervention amongst these therapies for patients. Data regarding efficacy has a body of literature that takes sides on all fronts, making efficacy of these interventions a topic of continued debate. An ever-present factor for consideration also remains—cost of therapy. This review examines current data available for cost of third-line therapies.
Recent Findings
In this body of literature regarding cost, there too remains ongoing debate, with no definitive answer. Data appears to support bladder Botox treatment being less costly in the short term (under 5 years), while sacral neuromodulation may have increased cost-effectiveness in the long-term (between 5 and 10 years). Percutaneous tibial nerve stimulation may be more cost-effective than sacral neuromodulation in the long-term, but has the associated challenges of patients needing to be present in offices at regular intervals for treatment duration. The generalizability of this data is limited by cost models being conducted in different countries, with varying healthcare systems and intervention techniques.
Summary
Therapies of the future, such as rechargeable technologies for sacral neuromodulation, appear to offer cost-saving opportunities that could impact therapy decision making in years to come. Rechargeable systems could significantly decrease the associated cost of sacral neuromodulation therapies. Ultimately, intangible clinical factors that influence patient care should still drive decision making and not be superseded by perceived treatment costs, especially as a definitive understanding regarding this remains elusive.