COST-UTILITY ANALYSIS OF MALE SLING AND ARTIFICIAL URINARY SPHINCTER FOR URETHRAL SPHINCTER DEFICIENCY IN THAILAND
Author(s)
Chanida Lertpitakpong, PhD1, Patkawat Ramart, PhD2, Sonthidetch Sivilaikul, MD3, Apirak Santingamkun, MD4, Premsant Sangkum, MD5, Wachira Kochakarn, MD5, Chaiyong Nualyong, MD2.
1¹ ASEAN Institute for Health Development, Mahidol University, Nakhonpathom, Thailand, 2Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 3Naval Medical Department, Somdech Phra Pinklao Hospital, Bangkok, Thailand, 4Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 5Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
1¹ ASEAN Institute for Health Development, Mahidol University, Nakhonpathom, Thailand, 2Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, 3Naval Medical Department, Somdech Phra Pinklao Hospital, Bangkok, Thailand, 4Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand, 5Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
OBJECTIVES: High costs of surgical interventions for male stress urinary incontinence (SUI), specifically artificial urinary sphincter (AUS) and male sling, hinder patient access and negatively impact quality of life. This study aimed to evaluate the cost-effectiveness of AUS and male sling compared to conservative management in men with SUI.
METHODS: A decision-tree/Markov model with a lifetime horizon was developed to conduct a cost-utility analysis of these surgical interventions compared to conservative care from a societal perspective. Patient cost data were obtained from four specialist hospitals, while all other model parameters were derived from relevant literature. Additionally, a budget impact analysis was performed from the payer's perspective over a 5-year time horizon. Cost-effectiveness and sensitivity analyses were conducted, with the ICER evaluated against a willingness-to-pay threshold of 160,000 THB/QALY.
RESULTS: Male sling was cost-effective (ICER: 114,254 THB/QALY). While AUS exceeded the threshold at hospital price (ICER: 178,298 THB/QALY), it offered a superior clinical success rate of 0.82 compared to 0.67 for male sling. Given that patients with a history of prostate radiotherapy or a negative repositioning test are ineligible for male sling and thus rely solely on AUS, we conducted a threshold analysis. This analysis demonstrated that reducing the AUS device cost to 200,000 THB would render the intervention cost-effective (ICER: 155,032 THB/QALY). Over a 5-year period, the total budget impact was 686 million THB, rising to 4.16 billion THB when accounting for lifelong pad use.
CONCLUSIONS: Male sling is a cost-effective treatment for persistent SUI. Although AUS exceeds the cost-effectiveness threshold, its higher clinical success and necessity for radiotherapy or repositioning-test-negative patients justify its use. These results provide essential evidence for price negotiations to enhance AUS access, aligning with universal health coverage principles.
METHODS: A decision-tree/Markov model with a lifetime horizon was developed to conduct a cost-utility analysis of these surgical interventions compared to conservative care from a societal perspective. Patient cost data were obtained from four specialist hospitals, while all other model parameters were derived from relevant literature. Additionally, a budget impact analysis was performed from the payer's perspective over a 5-year time horizon. Cost-effectiveness and sensitivity analyses were conducted, with the ICER evaluated against a willingness-to-pay threshold of 160,000 THB/QALY.
RESULTS: Male sling was cost-effective (ICER: 114,254 THB/QALY). While AUS exceeded the threshold at hospital price (ICER: 178,298 THB/QALY), it offered a superior clinical success rate of 0.82 compared to 0.67 for male sling. Given that patients with a history of prostate radiotherapy or a negative repositioning test are ineligible for male sling and thus rely solely on AUS, we conducted a threshold analysis. This analysis demonstrated that reducing the AUS device cost to 200,000 THB would render the intervention cost-effective (ICER: 155,032 THB/QALY). Over a 5-year period, the total budget impact was 686 million THB, rising to 4.16 billion THB when accounting for lifelong pad use.
CONCLUSIONS: Male sling is a cost-effective treatment for persistent SUI. Although AUS exceeds the cost-effectiveness threshold, its higher clinical success and necessity for radiotherapy or repositioning-test-negative patients justify its use. These results provide essential evidence for price negotiations to enhance AUS access, aligning with universal health coverage principles.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE434
Topic
Economic Evaluation, Health Technology Assessment, Medical Technologies
Topic Subcategory
Budget Impact Analysis
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Urinary/Kidney Disorders