Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;30(7):1045-1059.
doi: 10.1007/s00192-018-3814-0. Epub 2019 Feb 4.

Heterogeneity of cost estimates in health economic evaluation research. A systematic review of stress urinary incontinence studies

Sandra Zwolsman  1   2 , Arnoud Kastelein  3 , Joost Daams  4 , Jan-Paul Roovers  3 , B C Opmeer  5 ; WOMEN-UP Consortium: http://www.women-up.eu/consortium/
Affiliations

Heterogeneity of cost estimates in health economic evaluation research. A systematic review of stress urinary incontinence studies

Sandra Zwolsman et al. Int Urogynecol J. 2019 Jul.

Abstract

Introduction and hypothesis: There is increased demand for an international overview of cost estimates and insight into the variation affecting these estimates. Understanding of these costs is useful for cost-effectiveness analysis (CEA) research into new treatment modalities and for clinical guideline development.

Methods: A systematic search was conducted in Ovid MEDLINE & other non-indexed materials and Ovid Embase for articles published between 1995 and 2017. The National Health Service Economic Evaluation Database (NHS-EED) filter and the McMaster sensitive therapy filter were combined with a bespoke search strategy for stress urinary incontinence (SUI). We extracted unit cost estimates, assessed variability and methodology, and determined transferability.

Results: We included 37 studies in this review. Four hundred and eighty-two cost estimates from 13 countries worldwide were extracted. Descriptive analysis shows that hospital stay in gynecology ranged between €82 and €1,292 per day. Costs of gynecological consultation range from €30 in France to €158 in Sweden. In the UK, costs are estimated at €228 per hour. Costs of a tension-free vaginal tape (TVT) device range from €431 in Finland to €994 in Canada. TVT surgery per minute costs €25 in France and €82 in Sweden. Total costs of TVT range from €1,224 in Ireland to €5,809 for inpatient care in France. Variation was explored.

Conclusions: Heterogeneity was observed in cost estimates for all units at all levels of health care. CEAs of SUI interventions cannot be interpreted without bias when the base of these analyses-namely costs-cannot be compared and generalized.

Keywords: Health care costs; Health economic evaluation research; Health technology; Multinational; Standardized unit costs; Transferability.

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
Flowchart. Asterisk studies included in this review come from the following countries: Australia, Bosnia-Herzegovina, China, Canada, Egypt, Finland, France, Ireland, Netherlands, Spain, Sweden, United Kingdom, United States
Fig. 2
Fig. 2
Standardized unit costs per day of hospitalization vary between and within countries
Fig. 3
Fig. 3
Standardized unit costs per day of hospitalization day in the gynecology department vary between countries
Fig. 4
Fig. 4
Standardized unit costs for tension-free vaginal tape equipment vary between countries
Fig. 5
Fig. 5
Standardized unit costs for urodynamic testing vary among countries
See this image and copyright information in PMC

References

    1. Milsom I, Coyne KS, Nicholson S, Kvasz M, Chen CI, Wein AJ. Global prevalence and economic burden of urgency urinary incontinence: a systematic review. Eur Urol. 2014;65(1):96–98. - PubMed
    1. Hannestad YS, Rortveit G, Sandvik H, Hunskaar S. A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. J Clin Epidemiol. 2000;53(11):1150–1157. - PubMed
    1. Hunskaar S, Lose G, Sykes D, Voss S. The prevalence of urinary incontinence in women in four European countries. BJU Int. 2004;93:324–330. - PubMed
    1. Drummond MF, Schwartz JS, Jönsson B, Luce BR, Neumann PJ, Siebert U, Sullivan SD. Key principles for the improved conduct of health technology assessments for resource allocation decisions. Int J Technol Assess Health Care. 2008;24:244–258. - PubMed
    1. Rawlings T, Zimmern PE. Economic analyses of stress urinary incontinence surgical procedures in women. Neurourol Urodyn. 2016;35:1040–1045. - PubMed

Publication types

MeSH terms