An evaluation of the cost-effectiveness of duloxetine as a treatment for women with moderate-to-severe stress urinary incontinence

Abstract

SummaryThis economic evaluation estimated the incremental cost-effectiveness ratio (ICER) for inclusion of duloxetine as a primary care initiated treatment in the UKfor women with moderate to severe symptoms of stress urinary incontinence compared with standard treatment (pelvicfloor muscle training (PFMT) and surgery). Baseline evaluation assessed the use of duloxetine alone or in combination with PFMT as first-line treatment or as second-line to PFMT over a 2-year period. The baseline model was constructed to reflect best clinical practice, although real-life (suboptimal) clinical practice has been modelled as part of the sensitivity analysis. First-line use of duloxetine alone and in combination with PFMT is cost-effective when compared with standard treatment (ICERs: £8,730 and £5,854,respectively). Second-line use of duloxetine dominated standard treatment over 2 years. Assumptions made in the model were considered not to provide robust results over longer time horizons because of limited long-term treatment effectiveness data for standard existing treatments and for duloxetine. In determining the long-term cost-effectiveness of duloxetine, access to formal PFMT and surgery within existing standard treatment pathways in the UK should be considered, as should the uncertainty regarding the maintenance of long-term efficacy of PFMT and surgery.