Cost-effectiveness analysis of radiofrequency therapy versus surgery for the treatment of women with urinary incontinence: a long-term evaluation in Iran.

INTRODUCTION: Urinary incontinence (UI) is a common condition among women that imposes substantial economic burdens. Although surgery is the standard treatment, radiofrequency (RF) therapy has emerged as a less invasive alternative. This study evaluated the long-term cost-utility of surgery versus RF for UI management from the Iranian health system perspective. METHODS: A lifetime Markov model was developed for a cost-utility analysis. Cost data were obtained from Iranian sources, while clinical effectiveness, transition probabilities, and utility values were derived from the literature. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) was compared with a willingness-to-pay threshold of $18,234. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Surgery generated higher health benefits (10.93 QALYs) and higher costs ($14,666.98 PPP) than RF (10.81 QALYs; $13,935.35 PPP), yielding an ICER of $6,118.17 per QALY. Probabilistic sensitivity analysis indicated notable uncertainty, with surgery showing a 53% probability of being cost-effective versus 47% for RF. At willingness-to-pay thresholds below approximately $13,000, RF demonstrated a greater probability of cost-effectiveness. CONCLUSION: Surgery appears cost-effective for long-term UI management in Iran; however, uncertainty remains considerable. Given RF's potential advantage at lower willingness-to-pay thresholds, flexible policies supporting shared decision-making are recommended.