Trans-obturator tape compared with tension-free vaginal tape in the surgical treatment of stress urinary incontinence: A cost utility analysis - Abstract

Institute of Health Economics, Edmonton, AB, Canada. Department of Obstetrics and Gynaecology Department of Family Medicine, Surgery and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

To conduct an economic evaluation of the use of trans-obturator tape (TOT) compared with tension-free vaginal tape (TVT) in the surgical treatment of stress urinary incontinence (SUI) in women.

Design: Cost utility analysis from public-payer perspective, conducted alongside a randomised clinical trial (RCT).

Setting: Health services provided in Alberta, Canada.

Population: A total of 194 women who participated in the RCT, followed to 1 year from surgery.

Data collected on all women in the RCT, over 12 months following surgery. Comparisons undertaken between RCT groups for cost and quality-adjusted life-years (QALYs). Multiple imputation used for the 10% missing data. Bootstrapping used to account for sampling uncertainty. One-way sensitivity analysis conducted for productivity loss due to time away from work.

Utility - 15D questionnaire was used to calculate QALYs. Costs over 12 months-from trial data, health provider and provincial ministry of health.

The TOT group had a non-significant average saving of $1133 (95% CI -2793; 442), with no difference in average QALYs between groups (95% CI -0.02; 0.01). TOT was cost-saving in over 80% of bootstrapping replications, over a wide range of willingness-to-pay.

The bootstrapping replication results suggest that TOT could be cost-effective compared with TVT in the treatment of SUI. However, these results must be confirmed by longer-term assessment of clinical and economic outcomes, because of concern that surgical tape palpable at 12 months may lead to vaginal erosion and further treatment.

Written by:
Lier D, Ross S, Tang S, Robert M, Jacobs P.   Are you the author?

Reference: BJOG. 2011 Feb 4. Epub ahead of print.
doi: 10.1111/j.1471-0528.2010.02845.x

PubMed Abstract
PMID: 21291510

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