Cost-Minimization Analysis of Stress Urinary Incontinence Treatment Strategies.

IMPORTANCE

Stress urinary incontinence (SUI) imposes a substantial burden on patients and the health care system. Understanding cost differences among common treatment strategies can inform efficient, evidence-based care models.

OBJECTIVES

The objective of this study was to evaluate and compare the 1-year costs associated with 3 initial treatment strategies for SUI: pelvic floor muscle therapy (PFMT), vaginal pessary, and sling surgery.

STUDY

DESIGN

This was a retrospective cost-minimization analysis using a decision-tree model informed by a 5% national Medicare Fee-For-Service claims data set (2008-2016). Costs were calculated from a payer perspective and included all care within 6 months before and after the index treatment. One-year costs were also projected using a simplified American Urological Association (AUA) guideline-based pathway. Tornado analyses identified key cost drivers.

RESULTS

Of 16,695 patients, 46% received a pessary, 33.3% PFMT, and 20.5% sling surgery. Downstream sling utilization occurred in 5.6% of PFMT, 4.2% of pessary, and 3.1% of sling patients. Median 12-month costs were $2,346.79 (PFMT), $2,539.48 (pessary), and $5,517.16 (sling). Mean costs were $3,358.43 (PFMT), $3,171.94 (pessary), and $6,581.74 (sling). AUA-guideline-based pathway yielded $1,391.79 (PFMT), $1,430.48 (pessary), and $4,753.81 (sling). Cost drivers varied by treatment, including complications, bladder diagnostics, and downstream surgery.

CONCLUSIONS

At 1 year, sling surgery is the costliest first-line strategy for SUI. Pessary and PFMT demonstrate lower average costs. These findings support cost-conscious, evidence-based care pathways that prioritize conservative management as initial therapy, while acknowledging that cost minimization does not capture effectiveness or durability. Future research incorporating longer time horizons, bulking agents, and prospective utility measurement is needed for a full cost-effectiveness evaluation.