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Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial.

Publication ,  Journal Article
Harvie, HS; Amundsen, CL; Neuwahl, SJ; Honeycutt, AA; Lukacz, ES; Sung, VW; Rogers, RG; Ellington, D; Ferrando, CA; Chermansky, CJ; Thomas, S ...
Published in: J Urol
May 2020

PURPOSE: Sacral neuromodulation and intradetrusor onabotulinumtoxinA injection are therapies for refractory urgency urinary incontinence. Sacral neuromodulation involves surgical implantation of a device that can last 4 to 6 years while onabotulinumtoxinA therapy involves serial office injections. We assessed the cost-effectiveness of 2-stage implantation sacral neuromodulation vs 200 units onabotulinumtoxinA for the treatment of urgency urinary incontinence. MATERIALS AND METHODS: Prospective economic evaluation was performed concurrent with the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation vs. BoTulinum Toxin Assessment) randomized trial of 386 women with 6 or more urgency urinary incontinence episodes on a 3-day diary. Analysis is from the health care system perspective with primary within-trial analysis for 2 years and secondary 5-year decision analysis. Costs are in 2018 U.S. dollars. Effectiveness was measured in quality adjusted life-years (QALYs) and reductions in urgency urinary incontinence episodes per day. We generated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves. RESULTS: Two-year costs were higher for sacral neuromodulation than for onabotulinumtoxinA ($35,680 [95% CI 33,920-37,440] vs $7,460 [95% CI 5,780-9,150], p <0.01), persisting through 5 years ($36,550 [95% CI 34,787-38,309] vs $12,020 [95% CI 10,330-13,700], p <0.01). At 2 years there were no differences in mean reduction in urgency urinary incontinence episodes per day (-3.00 [95% CI -3.38 - -2.62] vs -3.12 [95% CI -3.48 - -2.76], p=0.66) or QALYs (1.39 [95% CI 1.34-1.44] vs 1.41 [95% CI 1.36-1.45], p=0.60). The probability that sacral neuromodulation is cost-effective relative to onabotulinumtoxinA is less than 0.025 for all willingness to pay values below $580,000 per QALY at 2 years and $204,000 per QALY at 5 years. CONCLUSIONS: Although both treatments were effective, the high cost of sacral neuromodulation is not good value for treating urgency urinary incontinence compared to 200 units onabotulinumtoxinA.

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Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

May 2020

Volume

203

Issue

5

Start / End Page

969 / 977

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urination
  • Urinary Incontinence, Urge
  • Treatment Outcome
  • Transcutaneous Electric Nerve Stimulation
  • Time Factors
  • Prospective Studies
  • Middle Aged
  • Male
  • Lumbosacral Plexus
 

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Harvie, H. S., Amundsen, C. L., Neuwahl, S. J., Honeycutt, A. A., Lukacz, E. S., Sung, V. W., … Thomas, S. (2020). Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial. J Urol, 203(5), 969–977. https://doi.org/10.1097/JU.0000000000000656
Harvie, Heidi S., Cindy L. Amundsen, Simon J. Neuwahl, Amanda A. Honeycutt, Emily S. Lukacz, Vivian W. Sung, Rebecca G. Rogers, et al. “Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial.J Urol 203, no. 5 (May 2020): 969–77. https://doi.org/10.1097/JU.0000000000000656.
Harvie HS, Amundsen CL, Neuwahl SJ, Honeycutt AA, Lukacz ES, Sung VW, et al. Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial. J Urol. 2020 May;203(5):969–77.
Harvie, Heidi S., et al. “Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial.J Urol, vol. 203, no. 5, May 2020, pp. 969–77. Pubmed, doi:10.1097/JU.0000000000000656.
Harvie HS, Amundsen CL, Neuwahl SJ, Honeycutt AA, Lukacz ES, Sung VW, Rogers RG, Ellington D, Ferrando CA, Chermansky CJ, Mazloomdoost D, Thomas S. Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial. J Urol. 2020 May;203(5):969–977.
Journal cover image

Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

May 2020

Volume

203

Issue

5

Start / End Page

969 / 977

Location

United States

Related Subject Headings

  • Urology & Nephrology
  • Urination
  • Urinary Incontinence, Urge
  • Treatment Outcome
  • Transcutaneous Electric Nerve Stimulation
  • Time Factors
  • Prospective Studies
  • Middle Aged
  • Male
  • Lumbosacral Plexus