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 were calculated based on treatment outcomes in our cohort. The financial burden on society was estimated based on costs of urinary incontinence (UI) from the 2023 Deloitte review, assuming patients needing third-line therapy are among those most affected by UI.

Cost-effectiveness analysis revealed that Botox provides the highest benefit-cost ratio (BCR) of 3.45, indicating superior value relative to cost. Sacral neuromodulation demonstrated a BCR of 2.99, while PTNS had the lowest BCR at 2.14. Over a 6-year period, total treatment costs were AU$13,682.50 for Botox, AU$23,736 for SNM, and AU$16,600 for PTNS. Total savings, calculated based on avoided societal UI costs, were AU$84,473.34 per patient for all three treatments. While SNM showed the highest efficacy (84% success rate), Botox was more cost-effective, with a success rate of 67% and shorter treatment intervals (every 9 months).

OAB imposes a substantial burden on patient quality of life and the healthcare system. Our findings underscore significant differences in cost-effectiveness among third-line treatment options. Although SNM demonstrates high clinical efficacy, Botox emerges as the most economically favorable treatment in public healthcare. Despite varying success rates, all three therapies offer substantial societal cost savings, supporting their continued use in managing OAB.