Urethral Bulking With Polyacrylamide Hydrogel Compared With Other Treatments for Stress Urinary Incontinence: A Cost-Effectiveness Analysis.

Publication Title

Obstetrics and gynecology

Authors

Olivia H Chang, Division of Female Urology, Voiding Dysfunction and Pelvic Reconstructive Surgery, University of California, Irvine, Irvine, the Department of Obstetrics and Gynecology, Providence Saint John's Health Center, Santa Monica, and Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, California; the Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, and Urogynecology and Reconstructive Pelvic Surgery, Yale University School of Medicine, New Haven, Connecticut; and the Division of Urogynecology and Pelvic Floor Disorders, Cleveland Clinic Women's Health Institute, Cleveland, Ohio.Follow
Jonathan P Shepherd
Lauren A Cadish
Shannon L Wallace
Brad St Martin
Eric R Sokol

Document Type

Article

Publication Date

3-1-2024

Keywords

Humans; Urinary Incontinence, Stress; Cost-Effectiveness Analysis; Acrylic Resins; Urethra; Treatment Outcome; Suburethral Slings; california; santa monica; sjci

Abstract

Our objective was to perform a cost-effectiveness analysis comparing polyacrylamide hydrogel urethral bulking with other surgical and nonsurgical treatments for stress urinary incontinence (SUI). We created a cost-effectiveness analysis using TreeAge Pro, modeling eight SUI treatments. Treatment with midurethral sling (MUS) had the highest effectiveness (1.86 quality-adjusted life-years [QALYs]), followed by polyacrylamide hydrogel (1.82 QALYs), with a difference (? 0.02/year) less than the minimally important difference for utilities of 0.03 annually. When the proportion of polyacrylamide hydrogel urethral bulking procedures performed in the office setting is greater than 58%, polyacrylamide hydrogel is a cost-effective treatment for SUI, along with pessary, pelvic floor physical therapy, and MUS. Although MUS is more effective and, therefore, the preferred SUI treatment, polyacrylamide hydrogel is a reasonable alternative depending on patient preferences and treatment goals.

Area of Special Interest

Women & Children

Specialty/Research Institute

Urology

Specialty/Research Institute

Obstetrics & Gynecology

DOI

10.1097/AOG.0000000000005503