To provide an overview of the urological management of spinal cord injured patients based on an economic analysis.
A literature search from January 1994 to December 2014 was performed using Medline and Embase database using the following keywords: cost-effectiveness; cost-benefit; cost-utility; spinal cord injury; neurogenic bladder; intermittent catheterization; antimuscarinics; botulinum toxin; sacral neuromodulation; tibial nerve; Brindley; sphincterotomy. The tool used for comparison was the QALY ("quality adjusted life years"); an indicator between 0 and 1 allowing the comparison between two medical treatments using cost per QALY.
Solifenacin (5 to 10mg) is the most cost-effective treatment with an incremental cost-effectiveness ratio (ICER) of 19,893 €/QALY compared to trospium 40mg, of 16,657 €/QALY compared to trospium 60mg, of 12,309 £/QALY compared to oxybutinin. Botulinum toxin A is also cost-effective with an ICER of 24,720 $/QALY compared to best supportive cares for anticholinergic-refractory neurogenic detrusor overactivity.
Solifenacin and botulinum toxin A appears to be the most cost-effective treatments for spinal injured urological cares. There is a pressing need to both increase and improve data collection and research on spinal cord injury.
Progres en urologie : journal de l'Association francaise d'urologie et de la Societe francaise d'urologie. 2016 Dec 14 [Epub]
C Guillot-Tantay, E Chartier-Kastler, Q Manach, M-A Perrouin-Verbe, P Denys, V Phé
Service d'urologie et de transplantation rénale, hôpital universitaire la Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, Assistance publique-Hôpitaux de Paris, 75013 Paris, France. Electronic address: ., Service d'urologie et de transplantation rénale, hôpital universitaire la Pitié-Salpêtrière, faculté de médecine Pierre-et-Marie-Curie, université Paris 6, Assistance publique-Hôpitaux de Paris, 75013 Paris, France., Service de médecine physique et réadaptation, hôpital Raymond-Poincaré, Assistance publique-Hôpitaux de Paris, 92380 Garches, France.