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 (Δ 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.
Obstetrics and gynecology. 2024 Jan 11 [Epub ahead of print]
Olivia H Chang, Jonathan P Shepherd, Lauren A Cadish, Shannon L Wallace, Brad St Martin, Eric R Sokol
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.