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The model also facilitated the budget impact analysis, which evaluated the direct cost impact on the Spanish NHS in four consecutive years if the number of women treated with SNM therapy increased. The outcomes of OAB in the treatment arms of the model were classified as success (��50% improvement in incontinence symptoms) or failure ([http://www.selleckchem.com/products/pf-06463922.html PF-06463922 ic50] OAB clinical or HRQoL outcomes or resource utilization and in relation to SNM and the comparators in the treatment of OAB. When published evidence was lacking, expert panel input was the source for model data. In the SNM arm of the model, treatment outcomes for the definitive implant of SNM up to 5 years were based on combined clinical trial data of two implantation methods [11], [12], [13]?and?[18]. It was assumed that patients first undergo screening for an average duration of 3.2 weeks (based on expert opinion), resulting in a positive response rate of 80% [18]?and?[19]. Thus, the first year treatment success rate of 90% (Table 2) is relevant to the proportion showing a positive response to screening. The clinical outcomes for BoNT-A in the first year were based on results observed in one-injection cycle trials in idiopathic OAB [12]?and?[20]. The expert panel provided additional input on treatment patterns, as follows: 1) Repeat injections at a 100-U dose were administered every [https://en.wikipedia.org/wiki/Phosphoprotein_phosphatase Phosphoprotein phosphatase] 9 months for BoNT-A responders (in 20% of patients in whom treatment failed in the first cycle, the dose was increased to 200 U). 2) Successive outcomes beyond the first year were estimated by applying a yearly treatment dropout rate of 7.5% to account for the treatment efficacy waning over time, discontinuation due to adverse events, or a search for a definitive solution as observed in patients with detrusor overactivity [21]. Treatment effects for OMT were based on 6-month treatment data in refractory patients who continued treatment [9]; this rate was maintained throughout the period. Augmentation cystoplasty [http://www.selleckchem.com/products/Bafilomycin-A1.html click here] (i.e., surgery to increase bladder capacity) was included as a treatment option after failure of SNM or BoNT-A, as shown in Fig. 1). To measure the impairment to patient HRQoL [2] due to OAB, QALY weights were assigned to the health outcomes of treatment success or failure. QALYs are a measure of the length of life adjusted for HRQoL related to a disorder, in addition to health benefits associated with treatment. Thus, 1 year of perfect health is equivalent to 1.0 QALY. The QALY weights applied to the current model were derived from the literature, because none of the SNM trials directly measured utilities associated with OAB outcomes.