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The cost of urogynaecological treatments: Which are more cost‐effective?
Author(s) -
FOOTE A. J.,
MOORE K. H.
Publication year - 2007
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/j.1479-828x.2007.00726.x
Subject(s) - medicine , quality of life (healthcare) , cost effectiveness , urinary incontinence , significant difference , surgery , urology , physical therapy , nursing , risk analysis (engineering)
Aims: To determine the cost‐effectiveness of four urogynaecological treatments. Materials: Two prospective trials were performed in which 205 women with urinary incontinence underwent urogynaecological treatments. The cost incurred and the improvement in quality of life (QOL) as a result of treatment was calculated as cost/quality‐adjusted life year (QALY) and then ranked in order of cost‐effectiveness. Results: The Nurse Continence Advisor (NCA) group ( N = 73) and the Urogynaecologist (UG) group ( N = 72) both had significant improvements in leaks per week and incontinence score. QOL improvement was also similar (1.5% vs 1.2%). The economic data found a similar improvement in pad usage costs ($A2.90 vs $A3.52). The clinician costs were significantly lower for the NCA group ($A60.00 vs $A105.00) ( P < 0.0001). The cost per QALY was significantly lower for the NCA group ($A28,009 vs $A35,312) ( P = 0.03). Both groups had significant improvements in pad testing and leaks per week. The cure/improvement rates were also similar at three months (100% vs 89%). There was no significant difference in the improvement in QOL between the laparoscopic colposuspension (LC) and open colposuspension (OC) groups (2.09% vs 1.54%). The economic data found a similar improvement in pad usage costs ($A11.74 vs $A16.17). The theatre costs were significantly higher for the LC group ($A403.45 vs $A266.94) ( P < 0.0001), however the overall costs were significantly lower ($A4,668 vs $A6,124) ( P < 0.0001). The cost/QALY was lower for the LC group ($A63,980 vs $A134,069), however this did not reach significance. Conclusions: Overall, on comparison of the cost/QALY's, conservative treatment of urinary incontinence by a NCA was the most cost‐effective.