INTRODUCTION AND OBJECTIVES: Neuromodulation for overactive bladder (OAB), including both electrical stimulation of nerves that control bladder function via direct implantable sacral nerve stimulation (SNS), or indirectly via percutaneous tibial nerve stimulation (PTNS), are increasingly recommended in the OAB treatment algorithm. The objective of this study was to estimate the costs of initial and on-going therapy of percutaneous tibial nerve stimulation (PTNS) and sacral nerve stimulation (SNS).
METHODS: A Markov model was constructed to compare the initial costs, on-going costs and cost-effectiveness of PTNS and SNS over 3 years. Cost data used average Medicare national physician payment and APC and DRG payments for hospital-based care and office visits. Clinical effectiveness, patient adherence-to-treatment rates and adverse- event rates were estimated by a review of the literature.
RESULTS: Costs for initial therapy were $1,773 for 12 weekly PTNS treatments and $1,546 for the initial SNS test stimulation with the cost for the SNS surgical implant of $22,892. Cumulative discounted 3-year costs were $4,416 for PTNS and $14,544 for SNS, including those who discontinued therapy, with 40% and 47% respectively remaining on therapy. The incremental cost-effectiveness ratio (ICER) of SNS was approximately $130,000 per additional patient remaining on treatment compared to PTNS. When considering only patients who completed the initial 12 weeks of PTNS therapy or SNS test stimulation successfully and then went on to subsequent therapy, costs were $5,721 and $25,031 at 3 years respectively, with 59% and 85% remaining on therapy, for an ICER of $74,300. See table.
CONCLUSIONS: PTNS and SNS are both effective neuromodulation therapies for OAB, with PTNS having a substantially lower cost. When SNS is used an additional 7% of patients would remain on therapy over 3 years vs. PTNS, but the cost per additional SNS patient would average $130,000.
FUNDING: Uroplasty, Inc.