title: Cost effectiveness of tension-free vaginal tape for the surgical management of female stress incontinence.
abstract: OBJECTIVE
  Stress urinary incontinence affects between 10 percent and 50 percent of women. Surgery is commonly recommended for troublesome incontinence that does not respond to nonsurgical management. Tension-free vaginal tape (TVT) is a newer, minimal access surgical sling procedure, which is being increasingly adopted worldwide. The cost-effectiveness of TVT in comparison with other surgical procedures, particularly open colposuspension, is assessed.
  
  
  METHODS
  Effectiveness estimates came from a systematic review of TVT compared with other surgical procedures (open and laparoscopic colposuspension, traditional slings, and injectables). Deterministic and probabilistic analyses were used to assess the likelihood of TVT being cost-effective. Sensitivity analyses assessed the impact of changing assumptions about cure rates and costs for TVT, cure rates for retreatment open colposuspension, and proportions of women who choose retreatment.
  
  
  RESULTS
  Reliable estimates of relative effectiveness were difficult to derive because the few randomized controlled comparisons had not been optimally analyzed or fully reported. Results of the economic model suggested that TVT dominates open colposuspension (lower cost and same quality of life years [QALYs]) within 5 years after surgery. Stochastic analysis indicated that the likelihood of TVT being cost-effective was 100 percent if decision-makers are unwilling to pay for additional QALYs. TVT's dominance depended on the assumption fact that retreatment open colposuspension has lower cure rates than a first colposuspension.
  
  
  CONCLUSIONS
  Analysis based on current short-term data indicates dominance of TVT over open colposuspension from approximately 5 years. There is a need for longer-term follow-up data from methodologically rigorous randomized trials to provide a sounder basis for estimating the relative benefits and cost implications.
authors.affiliation: Health Economics Research Unit, University of Aberdeen, UK. m.kilonzo@abdn.ac.uk
authors.forename: Mary
authors.initials: M
authors.lastname: Kilonzo
authors.forename: Luke
authors.initials: L
authors.lastname: Vale
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.forename: Adrian
authors.initials: A
authors.lastname: Grant
authors.forename: June
authors.initials: J
authors.lastname: Cody
authors.forename: Cathryn M A
authors.initials: CM
authors.lastname: Glazener
authors.forename: Sheila
authors.initials: S
authors.lastname: Wallace
authors.forename: Kirsty
authors.initials: K
authors.lastname: McCormack
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D019736:Prostheses and Implants / Q000191:economics*; D019057:Quality-Adjusted Life Years; D014550:Urinary Incontinence, Stress / Q000191:economics* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000191:economics* / Q000379:methods; D014621:Vagina / Q000601:surgery*