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Analytic model comparing the cost utility of TVT versus duloxetine in women with urinary stress incontinence

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Abstract

Introduction and hypothesis

The purpose of this study was to assess cost utility of duloxetine versus tension-free vaginal tape (TVT) as a second-line treatment for urinary stress incontinence.

Methods

A Markov model was used to compare the cost utility based on a 2-year follow-up period. Quality-adjusted life year (QALY) estimation was performed by assuming a disutility rate of 0.05.

Results

Under base-case assumptions, although duloxetine was a cheaper option, TVT gave a considerably higher QALY gain. When a longer follow-up period was considered, TVT had an incremental cost-effectiveness ratio (ICER) of £7,710 ($12,651) at 10 years. If the QALY gain from cure was 0.09, then the ICER for duloxetine and TVT would both fall within the indicative National Institute for Health and Clinical Excellence willingness to pay threshold at 2 years, but TVT would be the cost-effective option having extended dominance over duloxetine.

Conclusions

This model suggests that TVT is a cost-effective treatment for stress incontinence.

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Acknowledgements

Some of this work was undertaken by the National Collaborating Centre for Women's and Children's Health, which received funding from NICE. The views expressed in this publication are those of the authors and not necessarily those of the institute.

The Guideline Development Group (GDG), which produced the NICE Guidance (CG40), Urinary incontinence: The management of urinary incontinence in women, contributed to the development of an economic model, an extension of which is the subject of this paper.

Conflicts of interest

Paul Jacklin is employed by the National Collaborating Centre for Women's and Children's Health which are funded by NICE to produce clinical guidelines. Jonathan Duckett has received funding from Ethicon and Lilly to attend conferences. Arasee Renganathan has no disclosures to declare.

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Authors and Affiliations

  1. National Collaborating Centre for Women’s and Children’s Health, King’s Court (4th Floor), 2-16 Goodge Street, London, W1T 2QA, UK

    Paul Jacklin

  2. Department of Obstetrics and Gynaecology, Medway Maritime NHS Foundation Trust, Windmill Road, Gillingham, Kent, ME7 5NY, UK

    Jonathan Duckett & Arasee Renganathan

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  1. Paul Jacklin
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  2. Jonathan Duckett
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  3. Arasee Renganathan
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Correspondence to Arasee Renganathan.

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Jacklin, P., Duckett, J. & Renganathan, A. Analytic model comparing the cost utility of TVT versus duloxetine in women with urinary stress incontinence. Int Urogynecol J 21, 977–984 (2010). https://doi.org/10.1007/s00192-010-1132-2

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  • DOI: https://doi.org/10.1007/s00192-010-1132-2

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