Trial reportThe Journal of urology2020
Cost-Effectiveness of Sacral Neuromodulation versus OnabotulinumtoxinA for Refractory Urgency Urinary Incontinence: Results of the ROSETTA Randomized Trial.
Trial report in The Journal of urology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Treatment for refractory overactive bladder: a systematic review and meta-analysis of sacral neuromodulation and onabotulinumtoxinA.International urogynecology journal · 2021Pooled it
- Sacral Neuromodulation for Refractory Overactive Bladder: Closing the Gaps in Anatomy, Mechanisms, and Parameter Selection.Advances in therapy · 2026Review
- Peroneal electrical transcutaneous neuromodulation (peroneal eTNMWorld journal of urology · 2026Review
- What Role Does the Central Nervous System Play in Refractory LUTS, and What Are the Therapeutic Implications? ICI-RS 2025.Neurourology and urodynamics · 2026Review
- Chemodenervation Use for Overactive Bladder in Female Medicare Beneficiaries.Urogynecology (Philadelphia, Pa.) · 2026Article
- Urge fecal incontinence: are intramural rectal injections of botulinum toxin a long-term treatment option?Techniques in coloproctology · 2024Article
- Article
- Seminal papers in urology: two-year outcomes of Sacral Neuromodulation Versus OnabotulinumtoxinA for refractory urgency urinary incontinence: a Randomized Trial.BMC urology · 2024Review
- Sacral neuromodulation therapy for urinary and defecatory disorders: experience in a Latin American public hospital.Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia · 2024Article
- Cost-effectiveness of overactive bladder treatments from a US commercial and payer perspective.Journal of comparative effectiveness research · 2023Article
- Review
- Efficacy and Mechanism of Roxadustat plus Oral Iron in the Treatment of Elderly Chronic Kidney Disease with Anemia.Evidence-based complementary and alternative medicine : eCAM · 2022Article
- Sacral neuromodulation: troubleshooting needle placement.International urogynecology journal · 2021Article
- Recent advances in managing overactive bladder.F1000Research · 2020Review
- A Cost-effectiveness Model Comparing Urinary Biomarkers with Diuretic Renogram in Diagnosing Ureteropelvic Junction Obstruction in Children.Journal of Indian Association of Pediatric SurgeonsReview
Corrections and comments
- Commented on by
Authors and funding
12 authors at 10 institutions in 1 country.
Funding
Abstract
purposeSacral neuromodulation and intradetrusor onabotulinumtoxinA injection are therapies for refractory urgency urinary incontinence. Sacral neuromodulation involves surgical implantation of a device that can last 4 to 6 years while onabotulinumtoxinA therapy involves serial office injections. We assessed the cost-effectiveness of 2-stage implantation sacral neuromodulation vs 200 units onabotulinumtoxinA for the treatment of urgency urinary incontinence. MATERIALS AND
methodsProspective economic evaluation was performed concurrent with the ROSETTA (Refractory Overactive Bladder: Sacral NEuromodulation vs. BoTulinum Toxin Assessment) randomized trial of 386 women with 6 or more urgency urinary incontinence episodes on a 3-day diary. Analysis is from the health care system perspective with primary within-trial analysis for 2 years and secondary 5-year decision analysis. Costs are in 2018 U.S. dollars. Effectiveness was measured in quality adjusted life-years (QALYs) and reductions in urgency urinary incontinence episodes per day. We generated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.
resultsTwo-year costs were higher for sacral neuromodulation than for onabotulinumtoxinA ($35,680 [95% CI 33,920-37,440] vs $7,460 [95% CI 5,780-9,150], p <0.01), persisting through 5 years ($36,550 [95% CI 34,787-38,309] vs $12,020 [95% CI 10,330-13,700], p <0.01). At 2 years there were no differences in mean reduction in urgency urinary incontinence episodes per day (-3.00 [95% CI -3.38 - -2.62] vs -3.12 [95% CI -3.48 - -2.76], p=0.66) or QALYs (1.39 [95% CI 1.34-1.44] vs 1.41 [95% CI 1.36-1.45], p=0.60). The probability that sacral neuromodulation is cost-effective relative to onabotulinumtoxinA is less than 0.025 for all willingness to pay values below $580,000 per QALY at 2 years and $204,000 per QALY at 5 years.
conclusionsAlthough both treatments were effective, the high cost of sacral neuromodulation is not good value for treating urgency urinary incontinence compared to 200 units onabotulinumtoxinA.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.