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Activity Faculty

Patrick Culligan, MD, FACOG, FACS
Atlantic Health System
Morristown, New Jersey

Article Summary

Siddiqui NY, Amundsen CL, Visco AG, Myers ER, Wu JM. Cost-effectiveness of sacral neuromodulation versus intravesical botulinum A toxin for treatment of refractory urge incontinence. J Urol. 2009;182:2799-2804.


Sacral neuromodulation has emerged as a viable yet very expensive treatment option for patients with refractory urinary frequency, urge incontinence, and non-obstructive voiding dysfunction. Recently botulinum toxin A was approved by the FDA for refractory overactive bladder (patients with symptoms of urge urinary incontinence, urgency, and frequency, who have an inadequate response to, or are intolerant of an anticholinergic medication) and is also approved for neurogenic bladder. This study used a decision analytic model to determine relative cost-effectiveness of these two treatment options.



Expert Opinion

This study represents an excellent example of how to use decision analytic methods to answer important clinical questions. While one can argue that the results of this kind of study are merely a function of the assumptions contained within the model, the use of sensitivity analyses mitigates the impact of any single assumption. The authors did a great job of assessing the quality of life and clinical outcomes (as well as costs) in an objective way. The results are compelling.

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