Surgical treatment of stress urinary incontinence-trans-obturator tape compared with tension-free vaginal tape-5-year follow up: an economic evaluation

Abstract

Objective: 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 in women.

Design: Cost-utility and cost-effectiveness analyses from a public-payer perspective, conducted alongside a randomised clinical trial.

Setting: Health services provided in Alberta, Canada.

Sample: A total of 195 women participated in the randomised clinical trial, followed to 5 years postsurgery.

Methods: Comparisons were undertaken between study groups for cost and two health-outcome measures. Multiple imputation was used to estimate the 14% of missing data. Bootstrapping was used to account for sampling uncertainty. Sensitivity analyses were based on complete case analyses and the removal of a TVT patient with extreme health service cost.

Main outcome measures: The 15D instrument was used to calculate quality-adjusted life-years (QALYs) for the primary analysis. Absence of serious adverse events was also analysed. Costs were based on inpatient and outpatient hospital use data and practitioner fee-for-service claims data.

Results: The TOT group had a nonsignificant average saving of $2368 (95% CI -$7166 to $2548) and incremental gain of 0.04 QALYs (95% CI -0.06 to 0.14) compared with TVT. TOT was dominant in over 71% of bootstrap replications and cost-effective over a wide range of willingness-to-pay. Cost-effectiveness analysis using the absence of an serious adverse events provided similar results.

Conclusion: The results suggest that TOT is cost-effective compared with TVT in the treatment of stress urinary incontinence.

Tweetable abstract: The results of a 5-year cost-effectiveness analysis suggest that trans-obturator tape is cost-effective compared with tension-free vaginal tape in the treatment of stress urinary incontinence.

Keywords: Cost; cost utility; cost-effectiveness; stress/surgery; suburethral slings; treatment outcome; urinary incontinence.