Cost‐effectiveness analysis of tension‐free vaginal tape vs burch colposuspension for female stress urinary incontinence in the USA

Abstract

Objective• To compare the cost-effectiveness (CE) of tension-free vaginal tape (TVT) with that of burch colposuspension (BC) for the treatment of female stress urinary incontinence (SUI). Materials and Methods• A Markov-chain decision model was created to simulate treatment of SUI with TVT or BC using Treeage Pro 2011 software (Treeage Software Inc., Williamstown, MA, USA).• Costing data were obtained from the Medicare Resource-Based Relative Value Scale. • Data regarding the success of TVT vs BC were obtained from the peer-reviewed literature, as were corresponding utilities for different continence states.• The CE of each procedure was calculated and compared, and sensitivity analyses were performed. Results• At 10-year follow-up, TVT was more cost-effective (CE = $1495/quality-adjusted life year [QALY]) than BC (CE = $1824/QALY).• Sensitivity analysis showed that TVT was more costeffective than BC if the cost of the TVT device was <$3220.• If the probability of success after TVT was <42%, then BC became the more cost-effective strategy (CE = $1827/QALY). Conclusion• Our study showed that TVT was more cost-effective than BC as a treatment for female SUI.• Both cost of TVT device and efficacy of the procedure affect the CE analysis.

Surgical treatments for women with stress urinary incontinence: a systematic review of economic evidence

“…Seven studies were based in the US [14][15][16][17][18][19][20], six in the UK [21][22][23][24][25][26], six in Canada [27][28][29][30][31][32], two in Spain [33,34], one in Australia [35], one in Bosnia and Herzegovina [36], one in Finland [37], one in Italy [38] and one in the Netherlands [39]. Thirteen studies were model-based analyses [14][15][16][17][18][19][20][21][22][23][27][28][29], seven studies were within-trial evaluations [24-26, 30, 31, 37, 38], five were retrospective data analyses [32,33,35,36,40] and one was prospective non-randomised study [34]. Of the model-based studies, eight studies used a Markov model [14,…”

“…Thirteen studies were model-based analyses [14][15][16][17][18][19][20][21][22][23][27][28][29], seven studies were within-trial evaluations [24-26, 30, 31, 37, 38], five were retrospective data analyses [32,33,35,36,40] and one was prospective non-randomised study [34]. Of the model-based studies, eight studies used a Markov model [14,15,17,19,[21][22][23]27] and five used a decision tree [16,18,20,28,29]. Sixteen studies were CUA [14-17, 19-26, 30, 31, 34, 38], four were CEA [28,29,32,37], four were CCA [18,27,35,40], one was a CMA [33] and one was a CBA [36].…”

“…Sixteen studies were CUA [14-17, 19-26, 30, 31, 34, 38], four were CEA [28,29,32,37], four were CCA [18,27,35,40], one was a CMA [33] and one was a CBA [36]. Fifteen studies reported a health service perspective [17, 19-22, 24-29, 32-34, 38], two studies reported a societal perspective [14,37], one study reported a third-party payer perspective [16], two studies reported a public payer perspective [30,31] and six studies did not report a perspective [15,18,23,35,36,40]. One study reported a lifetime time horizon [14], six studies reported a 10-year time horizon [15, 17-19, 21, 22], nine studies reported a 1-year time horizon [16, 20, 24, 28-30, 33, 34, 37], seven studies reported a 2-5 year time horizon [23,25,27,31,32,38,40] and one study did not report a time horizon [35].…”

“…All of the included studies had a well-defined question posed in an answerable form and examined both the costs and effects of the alternative options 40]. Only six of the included studies did not state a viewpoint for the analysis or place the study in any particular decision-making context [15,18,23,35,36,40]. Three studies did not provide a comprehensive description of the competing alternatives, or only provided a comprehensive description of the intervention without focussing sufficiently on the comparator(s) [15,17,29].…”

“…Only six of the included studies did not state a viewpoint for the analysis or place the study in any particular decision-making context [15,18,23,35,36,40]. Three studies did not provide a comprehensive description of the competing alternatives, or only provided a comprehensive description of the intervention without focussing sufficiently on the comparator(s) [15,17,29]. Nineteen studies established the effectiveness of the surgeries through a randomised controlled clinical trial or systematic review of clinical evidence [14-19, 21-31, 37, 38].…”