UP-125 A Cost-Effectiveness Analysis of Bladder Management Strategies in Neurogenic Lower Urinary Tract Dysfunction after Spinal Cord Injury: A Publicly Funded Health Care Perspective
Thursday June 27, 2019 from

Samer Shamout, Canada

Clinical Fellow

Southern Alberta Institute of Urology

Rockyview General Hospital/ University of Calgary


A cost-effectiveness analysis of bladder management strategies in neurogenic lower urinary tract dysfunction after spinal cord injury: A publicly funded health care perspective

Samer Shamout1,3, Sara Nazha1,2, Alice Dragomir1,2, Lysanne Campeau1.

1Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada; 2Faculty of Medicine, McGill University, Montreal, QC, Canada; 3Department of Surgery, Division of Urology, University of Calgary, Calgary, AB, Canada

Introduction: Intermittent catheterization remains the ‘gold standard’ management strategy for neurogenic lower urinary tract dysfunction (NLUTD) related to spinal cord injury (SCI). This study aims to investigate the long-term cost-effectiveness of clean intermittent catheterization (CIC) compared with suprapubic catheters (SPC) and indwelling urethral catheters (UC) among individuals with neurogenic lower urinary tract dysfunction due to spinal cord injury from a Canadian healthcare perspective.

Methods: A Markov model with Monte Carlo simulation was developed with a cycle length of 1 year and lifetime horizon to estimate the incremental cost per quality-adjusted life years (QALYs). Patients were assigned to treatment with either CIC or SPC or UC. Transition probabilities, efficacy data, and utility values were derived from published literature and expert opinion. Costs were obtained from provincial health care system and hospital data in Canadian Dollars. The primary outcome was cost per quality-adjusted life year. A standard discount rate of 1.5% was applied annually. Probabilistic and one-way deterministic sensitivity analyses were performed to evaluate the robustness of the model.

Results: CIC had a lifetime mean total cost of $ 29,161 for 20.91 QALYs. While UC had a mean total cost of $31,657 for 18.95 QALYs, SPC mean cost was $ 29,491 for 19.14 QALYs. The model predicted that a 40-year-old patient with SCI would gain an additional 1.72 QALYs if CIC were utilized instead of SPC at an incremental cost savings of $330. CIC confer 1.96 QALYs and 3 discounted life-years gained compared to UC with an incremental cost savings of $2496.

Conclusions: Intermittent catheterization appears to be a dominant and more economically attractive bladder management strategy for NLUTD compared with SPC and/or UC from the public payer perspective over a lifetime horizon.

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