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National Collaborating Centre for Women's and Children's Health (UK). Urinary Incontinence in Women: The Management of Urinary Incontinence in Women. London: Royal College of Obstetricians and Gynaecologists (UK); 2013 Sep. (NICE Clinical Guidelines, No. 171.)

  • This guideline was partially updated in April 2019. The sections that are no longer current are marked as 'Updated 2019' and grey shaded in the PDF.

This guideline was partially updated in April 2019. The sections that are no longer current are marked as 'Updated 2019' and grey shaded in the PDF.

Cover of Urinary Incontinence in Women

Urinary Incontinence in Women: The Management of Urinary Incontinence in Women.

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Appendix OOveractive bladder procedures – health economics

Table O.1Resource use and unit costs used to estimate the cost of sacral nerve stimulation for the health economic model

Cost itemValueDescription of HRG codesSourceNotes
EITHER
Percutaneous nerve evaluation
Insertion of neurostimulator£1,096HRG code AA21Z intracranial prodecures except trauma with other diagnosesMedtronic and an NHS provider, 2012Based on OPCS code A70.4 Insertion of neurostimulator electrodes into peripheral nerve
Follow-up outpatient appointment£99HRG code - admitted patient care & outpatient procedures.
Urology follow-up attendance (multiprofessional)
Medtronic 2012Follow-up required for removal of PNE
External pulse generator£10NHS provider 2012Cost of generator is £350. Approximate use, 20 times.
Test stimulation kit£210Medtronic 2012
Nurse led visit (during 3 weeks)£70Non consultant -led face to face OPPSSRU 2011
Total cost PNE£1,485
OR
Two-stage trial (not all patients)
Tined lead£1,300NHS 2012Undertaken on the NHS
Lead introducer kit£200NHS 2012
External pulse generator£10NHS 2012
Procedure£1,096HRG code AA 21Z Intracranial Procedures Except Trauma with other Diagnoses - category 1 or 2NHS provider, checked with Medtronic, 2012Medtronic model has this cost again for removal of tined lead
Follow-up review£70
Nurse led visit (during 3 weeks)£70Non consultant -led face to face OPPSSRU 2011
Total, two-stage trial£2,746
Follow-up in case of failure (both test procedures)
Nurse led visit (during 3 weeks)£70Non consultant -led face to face OPPSSRU 2011
Procedure to explants temporary electrodes£1,096This may be less than the £1,096 tariff AA 21Z, as it is a small procedure
Permanent implant
Tined lead (included if two-stage trial not undertaken) (Not included in this analysis)£1,300NHS provider 2012Undertaken on the NHS
Lead introducer kit (included if two-stage trial not undertaken) (Not included in this analysis)£200NHS provider 2012
Implantable pulse generator£5,700NHS, checked with Medtronic, 2012
HRG code for SNS£2,441
Other estimates: £2,615 (With MFF*) £1,800 (excl MFF*)
HRG code AB01Z Complex neurological pain procedureMedtronic 2012HRG code for complex neurological pain procedures, Combined day case / ordinary elective tariff (£)
NHS 2012
Patient controlled programmer£500NHS, checked by Medtronic, 2012Hand-held device given to every patient (1 per patient)
Total cost permanent implant (excluding tined lead and lead introducer kit)£8,641
Replacement of implantable pulse generator
Device£5,700NHS 2012
HRG code for battery change£923OPCS-4 code
A70.2 Maintenance of neurostimulator in peripheral nerve
AB02Z Complex Major Pain Procedures
NHS 2012Estimate provided
Total cost replacement generator£6,623
SNS removal
SNS removal£923OPCS-4 code
A70.2 Removal of neurostimulator in peripheral nerve
AB02Z Complex Major Pain Procedures
AB01Z Complex neurological pain procedure
NHS 2012NHS
£2,441Medtronic
Total cost of SNS removal£923
*

Market Forces Factor, used to reflect differences in costs across the regions of the NHS.

Table O.2Resource use and unit costs used to estimate the cost of BoNT-A for the health economic model

Cost itemValueNotes
Procedure£403HRG LB14E (previously LB14C), tariff 2013
Drug cost£276.40Botulinum A toxin, 200 units BNF, June 2013
Catheter cost£102.20Assumes 4 catheters per day at £1.40 each, for 20% of women
Nurse led visit (during 3 weeks)£70Non consultant -led face to face OP, PSSRU 2013
Total initial injection cost851.60
Cost repeat procedure£249.801/3 cost of procedure and drugs, as model assumes a repeat injection is required every nine months. Catheter costs are the same
Catheter cost£102.20As above
Total repeat injection cost£352

Table O.3Alternative cost based on the costing template for BoNT-A in 2012 supplied by Medtronic

ResourceCodeSourceCost
1 course BoNT-A / 150 IUBNF Sept 2011207.30
Procedure and cystoscopy (endoscopy of the bladder_ for injection of boNT-A (day case)Bladder intermediate endoscopic procedureHRG LB14E (day case)£403
Review visitConsultant-led follow-up attendance –single professionalWF01A£187
Total£590
Copyright © 2013 National Collaborating Centre for Women's and Children's Health.

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Bookshelf ID: NBK328055

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