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Cost-Effectiveness of Third-Line Therapies for Overactive Bladder

  • Overactive Bladder and Lower Urinary Tract Symptoms (U Lee and S Adelstein, Section Editors)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

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 Ultimately, intangible clinical factors that influence patient care should still drive decision making and not be superseded by perceived treatment costs, especially as a definitive understanding regarding this remains elusive.

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Abbreviations

OAB:

overactive bladder

BoNT:

onabotulinumtoxinA

SNM:

sacral neuromodulation

PTNS:

percutaneous tibial nerve stimulation

ROSETTA:

Refractory Overactive Bladder: Sacral Neuromodulation versus Botulinum Toxin Assessment

UUI:

urgency urinary incontinence

AUA:

American Urological Association

QALYs:

Quality-adjusted life years

SUFU:

Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction

AC:

augmentation cystoplasty

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Division of Urology and Urologic Oncology, Department of Surgery, City of Hope, 412 W. Carroll Ave., Suite 200, Glendora, CA, 91741, USA

    Seth A. Cohen

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  1. Seth A. Cohen
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Contributions

All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.

Corresponding author

Correspondence to Seth A. Cohen.

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Seth A. Cohen declares that he has no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Overactive Bladder and Lower Urinary Tract Symptoms

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Cohen, S.A. Cost-Effectiveness of Third-Line Therapies for Overactive Bladder. Curr Bladder Dysfunct Rep 13, 153–157 (2018). https://doi.org/10.1007/s11884-018-0477-0

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  • DOI: https://doi.org/10.1007/s11884-018-0477-0

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