A cost-utility analysis of tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence.
OBJECTIVE
To assess the cost effectiveness of tension-free vaginal tape compared with open Burch colposuspension as a primary treatment for urodynamic stress incontinence.


METHODS
Cost-utility analysis alongside a multicentre randomised comparative trial.


METHODS
Gynaecology or Urology departments in 14 centres in the UK and Ireland, including University-associated teaching hospitals and district general hospitals.


METHODS
Women with urodynamic stress incontinence. Exclusion criteria were: (1) detrusor overactivity; (2) major voiding problems; (3) prolapse; (4) previous surgery for incontinence or prolapse.


METHODS
Resource use data were collected on all 344 patients in the trial, including length of hospital stay, time in theatre and management of complications; resource use was costed using UK unit costs at 1999-2000 prices.


METHODS
Health outcomes were expressed in terms of quality-adjusted life years (QALYs) between baseline and six months follow up, based on women's responses to the EQ-5D health questionnaire.


RESULTS
Tension-free vaginal tape resulted in a mean cost saving of pound 243 (95% CI pound 341 to pound 201) compared with colposuspension. Differential mean QALYs per patient (tension-free vaginal tape - colposuspension) was 0.01 (95% CI -0.01 to 0.03). The probability of tension-free vaginal tape being, on average, less costly than colposuspension, was 100%, and the probability of tension-free vaginal tape being more cost effective than colposuspension was 94.6% if the decision-maker was willing to pay pound 30,000 per additional QALY.


CONCLUSIONS
The results from this trial suggest that, over a post-operative period of six months, tension-free vaginal tape is a cost effective alternative to colposuspension. The results will need to be reassessed on the basis of longer follow up.
Manca
Andrea
A
Centre for Health Economics, University of York, UK.
Sculpher
Mark J
MJ
Ward
Karen
K
Hilton
Paul
P
D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011126:Polypropylenes / Q000191:economics; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D013526:Surgical Mesh / Q000191:economics*; D013536:Suture Techniques; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000191:economics / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
D011126:Polypropylenes