The objective of this study was to determine the cost-effectiveness of urodynamic testing in women who have either pure stress incontinence or mixed incontinence with predominant stress incontinence.
A decision analysis model was used based on recent randomized controlled data. Costs and complications were based on literature and Medicare. Sensitivity analysis (one-way) was used.
In patients with pure stress urinary incontinence or mixed urinary incontinence, opting for immediate midurethral sling placement was both less costly and more effective (dominated) than performing urodynamic testing and subsequently individualizing treatment decisions if history and urodynamics were discordant. One-way sensitivity analysis showed to achieve a cost of adding urodynamic testing to less than $5,000 per subjective cure, the subjective cure rate would have to increase from 71.2% to 79.5%. Alternatively, if the cost of urodynamic testing was decreased from $350 to free, it would still not be cost-effective because of the lower subjective cure rate in this population.
In women who have either pure stress incontinence or mixed incontinence with predominant stress incontinence, urodynamic testing does not add effectiveness in subjective treatment outcomes but does add cost.