The management of overactive bladder syndrome (OAB) often involves third-line treatments such as percutaneous tibial nerve stimulation (PTNS), intravesical botulinum toxin (Botox), and sacral neuromodulation (SNM). This study aims to assess the therapeutic outcomes and cost-effectiveness of these treatment modalities within a tertiary public hospital setting.

A retrospective audit was conducted from 2019 to 2023 to evaluate the efficacy and cost-effectiveness of PTNS, Botox, and SNM. Cost data was sourced from the government healthcare portal to assess the overall expenditure associated with each treatment. Efficacy rates for each modality were calculated based on patient outcomes from our cohort. Financial burden on society was estimated based off the costs of urinary incontinence (UI) as per the 2023 Deloitte review, given this cohort is needing third line therapy for OAB, reasonable to assume they are some of the most affected by UI.

Cost-effectiveness analysis revealed that Botox continues to provide the highest benefit-cost ratio (BCR) of 20.5, offering superior value relative to its cost. Sacral neuromodulation showed a BCR of 18.13, while PTNS offered the lowest BCR of 12.24, indicating it is the least cost-effective option among the three. Notably, it would take approximately 11.3 Botox treatments to equal the cost of one SNM procedure. Considering the Medtronic Interstim II neurostimulator’s median battery life of 6.2 years, Botox treatments administered every 9 months would require 8.3 treatments, resulting in a cost saving of over AU$6,000 when compared to SNM.

OAB represents a significant burden both in terms of patient quality of life and healthcare costs. This study highlights the substantial differences in cost-effectiveness between third-line treatments for OAB. While sacral neuromodulation demonstrates high efficacy, Botox remains the most cost-effective treatment option, providing a favorable benefit-cost ratio. Our findings suggest that while SNM is effective, its high cost makes Botox a more economically viable choice. Importantly each modality offers significant benefits of alleviating financial burden of OAB on the economic system and are thus viable options for treatment especially in a public healthcare setting.