Corresponding Author:
Dr Manvi Verma, MD, DNB
Department of Obstetrics & Gynaecology, All India Institute of Medical
Sciences, Rishikesh, Uttarakhand, India, 249201
manvi278@gmail.com
+919469388553
Short Title: Cost-effectiveness analysis of stress incontinence
treatment
Dear Editor,
We commend Chang et al for their elaborate work on analyzing the
cost-effectiveness of surgical and non-surgical treatment strategies for
stress urinary incontinence.1 The authors modeled
seven pathways for the treatment of stress urinary incontinence and
found out that incontinence pessary, pelvic floor muscle physical
therapy, and midurethral slings were the only cost-effective treatment
options. Amongst non-surgical treatment modalities, pelvic floor muscle
therapy is the most cost-effective strategy.1,4
The analysis done by the authors has added a much-needed boost to
finding cost-effective solutions for women with stress urinary
incontinence and may have implications for improving patient care and
decreasing financial toxicity. It is commendable that surgeons from
geographically diverse institutions in the United States have developed
treatment plans for individual pathways. Also, the time duration has
been set to two years which is also absolutely logical as maximum
complications and retreatments will occur within this period. We feel
that the outcomes measured (Incremental Cost-Effectiveness Ratio and
Quality-Adjusted-Life-Years) by the author are appropriate and can help
in better policy formulation.
In nations with resource constraints like India, general medical
insurance schemes like Ayushman Bharat have provided a silver lining to
the common man. However, when the cost of the implant is not covered
under such General Insurance Cover (GIC), patients are forced to opt for
a low-quality alternative option with less durability. In such cases,
the role of finding cost-effective solutions comes into the picture as
affordable solutions need to be quality controlled and regulated under
minimum specific standards, otherwise, they may lead to poor surgical
results in the long run. Midurethral slings have been found as the most
cost-effective surgical option unanimously.1-3We
suggest that the material of the mesh also needs to be included in such
cost-effectiveness analysis and long-term comparative trials be
conducted on the same subject.
We believe that the inherent limitation of retrospective studies for
such cost-effectiveness analysis is that, they can miss many additional
real-life costs incurred by the patients as the data has been collected
from medical reimbursement data or published literature. While planning
a surgery for stress urinary incontinence factors like cost of
consumables, complications, re-treatments, complementary tests,
treatments, and consultations that would be carried out before and after
each surgery also play a role.3 Also, COVID-19 has
made an unprecedented impact on the affordability of common masses where
the quality-of-life health issues like stress urinary incontinence have
taken the backburner.
We suggest that prospective multi-center trials should be conducted to
assess the real economic ramifications and the holistic expenses
incurred by patients. This will help us move towards a better
understanding and crowd-sourcing of solutions to provide cost-effective
health care services to women with stress urinary incontinence, which
affects almost one-third of the female population in India, similar to
USA.
Funding/Financial support: No funding was received for this
study
Acknowledgements : None
Disclosure of interests : The authors report no conflict of
interest