Cost-effectiveness analysis of radiofrequency therapy versus surgery for the treatment of women with urinary incontinence: a long-term evaluation in Iran.

BACKGROUND

Urinary incontinence (UI) imposes significant economic burdens on women. Evidence comparing the long-term cost-effectiveness of standard surgery versus minimally invasive radiofrequency (RF) therapy is scarce, particularly in resource-limited settings. We evaluated the cost-utility of surgery versus RF for UI from the Iranian health system perspective.

RESEARCH DESIGN AND

METHODS

A lifetime Markov model compared costs (in purchasing power parity, PPP) and quality-adjusted life years (QALYs) of surgery and RF. We used local cost data and international clinical parameters. The incremental cost-effectiveness ratio (ICER) was evaluated against an $18,234 willingness-to-pay (WTP) threshold. Deterministic and probabilistic sensitivity analyses (PSA) assessed decision uncertainty.

RESULTS

In the base-case analysis, surgery yielded greater health benefits (10.93 QALYs) at a higher cost ($14,666.98 PPP) compared to RF (10.81 QALYs; $13,935.35 PPP). The ICER was $6,118.17 per QALY. However, PSA revealed considerable uncertainty: surgery had a 53% probability of being cost-effective compared to 47% for RF. Below a $13,000 WTP threshold, RF demonstrated a higher probability of being cost-effective.

CONCLUSIONS

While surgery is the cost-effective strategy for long-term UI management in Iran at the current threshold, decision uncertainty is substantial. A flexible policy encouraging shared decision-making is recommended, as RF is preferable at lower WTP thresholds.