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UPJ INSIGHT Long-Term Cost Analysis of Third-Line Treatment Options for Overactive Bladder
By: Mary Pelling, MD, Emory University School of Medicine, Atlanta, Georgia; Dattatraya Patil, MBBS, Emory University School of Medicine, Atlanta, Georgia; Jessica Hammett, MD, Emory University School of Medicine, Atlanta, Georgia | Posted on: 19 Jan 2024
Pelling M, Hammett J, Patil D. Long-term cost analysis of third-line treatment options for overactive bladder. Urol Pract. 2024;11(1):61-70.
Study Need and Importance
Overactive bladder (OAB) is a distressing condition that significantly impacts patients’ lives, and often necessitates third-line treatments when conservative and medication approaches prove ineffective. However, choosing the right treatment can be challenging due to factors like cost, safety, and long-term efficacy. This study aimed to address this critical need by conducting a comprehensive long-term cost analysis of three third-line OAB treatment modalities: sacral neuromodulation (SNM), botulinum toxin injections, and percutaneous tibial nerve stimulation (PTNS).
What We Found
The study analyzed data from both the MarketScan and Medicare supplemental databases. It revealed that SNM, while having a higher initial cost, emerged as the most cost-effective option in the long term, offering substantial savings over 15 years compared to botulinum toxin injections and PTNS. Furthermore, PTNS, which necessitates regular maintenance visits, proved to be the most expensive option (Table).
Table. Fifteen-Year Predicted Payments for Third-Line Overactive Bladder Treatment Type in the MarketScan and Medicare Cohorts
| Total net payment, $ | Patient contribution, $ | |
|---|---|---|
| PTNS MarketScan | 102,295.80 | 9276.60 |
| BTX MarketScan | 67,968.00 | 2850.00 |
| SNM MarketScan | 5179.10 | 59.10 |
| PTNS Medicare | 88,173.6 | 3666.00 |
| BTX Medicare | 54,261.00 | 1110.00 |
| SNM Medicare | 6099.00 | 60.00 |
| Abbreviations: BTX, botulinum toxin injection; PTNS, percutaneous tibial nerve stimulation; SNM, sacral neuromodulation. | ||
Limitations
Several assumptions were made in this analysis, such as the assumed time of effectiveness for each treatment and the frequency of treatments pursued by patients, which could influence the cost estimates. The study also had limitations associated with the databases used, including a lack of data from small employers and incomplete information on out-of-pocket costs for patients. Additionally, the analysis did not consider adverse outcomes or patient heterogeneity, which could impact the overall cost-effectiveness of treatments.
Interpretation for Patient Care
This study provides valuable insights for clinicians and patients facing decisions about third-line OAB treatments. It underscores the importance of considering not only short-term costs but also long-term projections when making treatment choices. SNM, despite its higher initial expense, emerges as the most cost-effective option over 15 years. These findings can guide health care decisions and improve patient care by helping individuals make informed choices that align with their preferences and financial considerations.
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