Login to Access Video or Poster Abstract: MP32-14
Sources of Funding: None

Introduction

The artificial urinary sphincter (AUS) remains the &[Prime]gold standard&[Prime] for the treatment of post prostatectomy stress urinary incontinence (PPSUI). However, in recent years, minimally invasive, less expensive sling device (AdVance) are offered as potential alternative treatments. We sought to investigate the long-term cost-utility of the AUS compared with Transobturator Retroluminal Repositioning Sling (AdVance) in the treatment of severe PPSUI.

Methods

A Markov model with Monte-Carlo simulation was developed to estimate the incremental cost-effectiveness ratio (ICER) of AUS vs. AdVance sling from a provincial payer perspective over a 10-year period. Probability estimates, success rates, healthcare resources and utilities were obtained from published literature when available or by expert opinion. Cost data included in this model were obtained from provincial health care insurance system and hospital data in 2016-Canadian Dollars.

Results

AUS Implantation had a 10-year mean total cost of $12299 (SD±3509) for 8.53 quality-adjusted life years (QALYs). On the other hand, AdVance sling had a mean total cost of $20675 (SD±12435) for 7.98 QALYs. The cost-utility analysis over a 10-year period showed that AUS becomes cost-effective when compared to AdVance sling starting the 4th year in the treatment period. The incremental cost savings of AUS over 10-year period was $8376 with an added effectiveness of 0.55 QALYs. Consequently, the AUS implementation is the dominant strategy over the AdVance sling over a 5- and 10-year time-horizon.

Conclusions

Although the initial cost of sling is attractive, superior long-term outcomes are demonstrated with durable high success rate of AUS in men with severe PPSUI. Hence, the AUS implementation strategy over a 10-year period time is estimated to be more economical to our health care system. More studies are needed to define utility values for health states experienced by males with PPSUI. This will enhance our ability to develop more accurate cost-utility models.

Funding

None