Cost-utility of implantable tibial neuromodulation (Revi) versus conservative therapy for urgency urinary incontinence in adults: a US payer perspective.

For nursing students

Study summary

This article, published in the Journal of Medical Economics on January 1, 2026 (DOI: 10.1080/13696998.2026.2655592), investigates whether a new medical device called Implantable Tibial Neuromodulation (ITNM) with an external wearable battery, known as the Revi System, is cost-effective for treating Urgency Urinary Incontinence (UUI). UUI is defined by sudden, strong urges to urinate that are difficult to control and can lead to accidents. This condition significantly impacts quality of life and daily activities for adults. The study specifically compares ITNM with conservative treatments like behavioral therapy and medication from the perspective of healthcare payers (such as insurance companies or government programs). For nursing students, this article is valuable because it demonstrates how economic models are used in health policy decisions to evaluate new therapies. It highlights that these models rely on assumptions about disease progression, treatment effectiveness, costs, and patient preferences.

The research uses a complex computer modeling technique called a Markov model. This type of model simulates patient outcomes over time by placing them into different 'health states' (e.g., responder to treatment, non-responder) and allowing transitions between these states based on probabilities derived from existing clinical data. In this study, the ITNM clinical parameters were primarily sourced from the OASIS pivotal trial, which involved 150 participants. The model's uncertainty was addressed using Monte Carlo simulations (20,000 runs). Health states in the model included responder and non-responder status for UUI treatment, with pathways for rescue interventions if initial treatments failed or were ineffective (such as onabotulinumtoxinA injections, sacral neuromodulation, or percutaneous tibial nerve stimulation). The model also incorporated downstream event modules to account for potential complications or comorbidities associated with UUI and its treatment. These included risks of falls, urinary tract infections, incontinence-associated dermatitis (skin irritation), depression, cognitive decline/dementia, and even nursing-home entry.

The study's main findings are based on a 3-year simulation period from the US payer perspective, considering only direct medical costs. The results indicate that ITNM with Revi was both more effective and less costly than conservative treatments over this three-year timeframe. Specifically: 1. Mean total healthcare costs were $39,308 for patients receiving ITNM versus $43,737 for those on conservative therapy, resulting in a net cost saving of -$4,428 with ITNM. 2. In terms of quality-adjusted life-years (QALYs), which measure both the quantity and quality of life gained, patients using ITNM achieved an average of 2.188 QALYs over three years, compared to 1.940 QALYs for those on conservative treatments. This represents a gain of +0.249 additional QALYs with ITNM. 3. The incremental cost-effectiveness ratio (ICER) was calculated as -$17,818 per QALY gained. A negative ICER means that the intervention is not only more effective but also less costly than the alternative; this is termed 'dominant' in economic evaluations and indicates strong value. 4. The incremental net monetary benefit (INMB) at a willingness-to-pay threshold of $40,000 per QALY was calculated as $14,369 for ITNM compared to conservative therapy. The analysis showed that there was a 100% probability of cost-effectiveness across various thresholds ranging from $20,000/QALY up to $150,000/QALY. Key factors influencing the model's outcomes were found to be the utility (quality-of-life impact) associated with being a responder to ITNM and parameters related to fall-related events.

It is important for students to understand that while this abstract provides detailed findings from a specific model run, it does not offer information on sample sizes for clinical trials underlying some of these parameters beyond what was mentioned for the OASIS trial (N=150). Additionally, details about the study population are limited in the abstract itself. The analysis adopts a US payer perspective and includes only direct medical costs. Some event risks were applied from general population-level sources and may not fully capture individual patient variations or heterogeneity.

The 3-year base-case horizon of the model might miss longer-term durability effects, although extended-horizon scenarios (not detailed in this abstract) reportedly support consistent findings. Overall, over a three-year period, ITNM with an external wearable battery was found to improve quality-adjusted survival and lower overall payer costs compared with conservative therapies for UUI. This supports its inclusion as a value-consistent minimally invasive therapy option from the perspective of healthcare payers in the US.