MacDiarmid, S.A. et al. (2010). Poster, Society for Urodynamics and Female Urology, St. Petersburg, FL.
INTRODUCTION AND OBJECTIVE: Anticholinergic therapy is first line treatment for overactive bladder (OAB) but is limited by side effects or lack of therapeutic goal attainment. Neuromodulation is an effective treatment alternative and its efficacy has been well established. The objective of this study was to review the comparative effectiveness of PTNS and SNS using published clinical and cost data to determine the most cost effective treatment strategy.
METHODS: A Markov model was constructed to compare costs, clinical effectiveness and the adverse events profiles of PTNS and SNS over a 6 yr. treatment period. Five strategies were compared: PTNS ONLY, SNS ONLY, PTNS FIRST (followed by SNS), SNS FIRST (followed by PTNS) or PATIENT CHOICE of PTNS or SNS. Cost data used average Medicare payments for CPT codes to report services and the associated physician, APC and DRG payments. Clinical effectiveness, defined as the percent of patients still receiving therapy was determined by a review of literature of patient response, adverse events and long term efficacy.
RESULTS: Total cumulative 6 year costs were: PTNS ONLY: $9,000; SNS ONLY: $15,000; PTNS FIRST: $15,000; SNS FIRST: $20,000 and $18-$22,000 for PATIENT CHOICE (75%–% chose PTNS). The costs were substantially lower in strategies with PTNS ONLY, PTNS FIRST, or PATIENT CHOICE with PTNS chosen > 50% of the time. Clinical effectiveness for each of the treatment strategies varied from 34% to 79%. All patient choice models were the most effective (78% - 79%), PTNS FIRST and SNS FIRST were equally effective at 74%. Over 6 years, PTNS ONLY was 57% effective; SNS ONLY was least effective at 34%. Ranking them from least expensive/effective to most costly/most effective: PTNS ONLY, PTNS FIRST and PATIENT CHOICE with 75% PTNS.
CONCLUSION: The use of PTNS to treat overactive bladder over a 6 yr period proved to be both clinically and cost effective.
Source: Original Poster
