Treatment of stress urinary incontinence with non-animal stabilised hyaluronic acid/dextranomer (NASHA/Dx) gel - An analysis of utility and cost

Background: The Zuidex (R) system is a treatment for stress urinary incontinence comprising four prefilled syringes of non-animal stabilised hyaluronic acid/dextranomer (NASHA/Dx) gel and the Implace (TM) device. This study aimed to investigate utility (patients' preferences for given health states) with NASHA/Dx gel therapy and to compare resource utilisation of NASHA/Dx gel treatment with tension-free vaginal tape (TVT). Methods: Utility was measured using EuroQol (EQ-5D), a generic utility instrument. For the cost of NASHA/Dx gel treatment, data were collected prospectively from participants in a 12-month efficacy study (n = 82). Retrospective analysis of a comparable group of patients (n = 77; 3-6 months' follow-up) was used to obtain equivalent costs for TVT. Costs were analysed for both Sweden and France. Results: NASHA/Dx gel produced a utility gain of 0.048 at 3 months and 0.014 at 12 months. The estimated mean total 3-month cost per patient with NASHA/Dx gel was Euro2412 in Sweden and Euro2005 in France. The corresponding values for 12 months, including 14% of patients undergoing TVT, were Euro3370-Euro3417 and Euro2935-Euro2976 for Sweden and France, respectively. In comparison, the total costs of treatment with TVT over 3-6 months were Euro3169-Euro3504 and Euro5181-Euro5471 for Sweden and France, respectively. Conclusions: NASHA/Dx gel provides utility benefits that are similar to those previously reported for TVT and, depending on the country in which the treatment is performed, are associated with similar or lower overall costs in the short to medium term. From an economic perspective, NASHA/Dx gel could be considered at least as favourable as TVT, pending the availability of long-term effectiveness data.