OBJECTIVES: Despite being considered the ''gold standard'' for the treatment of severe male postprostatectomy incontinence, the artificial urinary sphincter (AUS) is not incorporated and provided in the Brazilian public health system. The objective of the presented study was to evaluate the cost-utility of AUS in this perspective.

METHODS: A decision tree model was developed to estimate incremental costs and quality-adjusted life years (QALYs) of AUS compared to best supportive care (BSC) in the Brazilian public health system perspective. Patients start the model with severe urinary incontinence resulting from radical prostatectomy. After entering the model, patients may undergo implantation of an artificial urinary sphincter or remain untreated for the health condition. For both choices, the patient can remain in the state of severe urinary incontinence (5 pads per day) or move to the state of complete continence (0 pads per day). Probability estimates, healthcare resources and utilities were obtained from published literature when available or by expert opinion. Uncertainty was analyzed using deterministic and probabilistic sensitivity analysis.

RESULTS: AUS led to an expected gain of 1.49 QALYs versus BSC at an incremental cost of US$ 13,864 presenting an incremental cost-effectiveness ratio (ICER) of 9,332 US$/QALY. The results of one-way sensitivity analysis revealed that the key parameters with greatest impact on the ICER value are probabilities of the model's decision nodes and the QALY-measured outcome data of both urinary incontinence treatment options.

CONCLUSIONS: AUS provided QALY gains when compared to BSC in patients with severe male postprostatectomy incontinence and is very close to the last cost-effectiveness threshold recently established by the Brazilian Public Health System, which is equivalent to 7,737 US$/QALY.