Surgery versus collagen for female stress urinary incontinence: economic assessment in Ontario and Quebec.
OBJECTIVE
The purpose of this study was to evaluate the cost-effectiveness of surgery versus collagen injection to treat female stress urinary incontinence after the failure of initial surgical treatment. The analysis was conducted from the health care system perspectives of Ontario and Quebec.


METHODS
A decision-tree was constructed to compare each of three surgeries (i.e., retropubic suspension, transvaginal suspension, sling procedures) with collagen. An average cost estimate was generated for each intervention, as was an incremental cost-effectiveness ratio for each surgery-collagen comparison.


RESULTS
In both Ontario and Quebec, the treatment with the lowest average cost was collagen (Ontario: collagen = 2695 dollars; Quebec: collagen = 2718 dollars). However, the surgeries had higher probabilities of success (defined as 'cure' - no urine leakage during follow-up examinations), with point estimates of at least.79 (.53 for collagen). Incremental cost-effectiveness ratios for the base case analyses of all treatment comparisons indicated that the cost to cure an additional patient with surgery could range from 1824 dollars to 6814 dollars in Ontario and 1388 dollars to 3008 dollars in Quebec. These ratios were sensitive to changes in the mean number of injections for collagen patients and to a reduction in the length of hospital stay for surgery to 1 day.


CONCLUSIONS
Collagen injection may be cost-effective as a follow-up treatment to initial surgical failure in both Ontario and Quebec when the number of injections is kept to a minimum and hospital stays after surgery are relatively lengthy. Otherwise, surgery may be cost-effective.
D003094:Collagen / Q000008:administration & dosage / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D005260:Female; D006801:Humans; D007267:Injections; D007902:Length of Stay / Q000191:economics; D009864:Ontario; D011792:Quebec; D012086:Reoperation / Q000191:economics; D014550:Urinary Incontinence, Stress / Q000191:economics* / Q000628:therapy*; D013520:Urologic Surgical Procedures / Q000191:economics* / Q000379:methods
D003094:Collagen