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Trans‐obturator tape compared with tension‐free vaginal tape in the surgical treatment of stress urinary incontinence: a cost utility analysis
Author(s) -
Lier D,
Ross S,
Tang S,
Robert M,
Jacobs P
Publication year - 2011
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.2010.02845.x
Subject(s) - urinary incontinence , medicine , randomized controlled trial , population , gynecology , surgery , physical therapy , environmental health
Please cite this paper as: Lier D, Ross S, Tang S, Robert M, Jacobs P, for the Calgary Women’s Pelvic Health Research Group. Trans‐obturator tape compared with tension‐free vaginal tape in the surgical treatment of stress urinary incontinence: a cost utility analysis. BJOG 2011;118:550–556. 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 (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. Methods 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. Main outcome measures Utility – 15D questionnaire was used to calculate QALYs. Costs over 12 months—from trial data, health provider and provincial ministry of health. Results 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. Conclusion 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.