A cost-effectiveness analysis of tension-free vaginal tape versus laparoscopic mesh colposuspension for primary female stress incontinence.
BACKGROUND
Evaluation of cost-effectiveness of new surgical techniques is important. As the data on incontinence procedures are scarce, we evaluated the cost-effectiveness of tension-free vaginal tape procedure and laparoscopic mesh colposuspension as a primary surgical treatment for female stress urinary incontinence.


METHODS
In four university teaching hospitals and two central hospitals 128 stress incontinent women were randomized to tension-free vaginal tape procedure (n=70) or laparoscopic mesh colposuspension (n=51) in order to investigate the clinical performance of these two procedures. Primary objective clinical outcome measures were: stress test and 48-h pad test. Secondary subjective outcome measures were health-related quality of life measured in terms of visual analogue scale and Urinary Incontinence Severity Score. Alongside the clinical trial, a cost-effectiveness analysis for the main outcome measures was performed.


RESULTS
The changes in the 48-h pad test result did not reach statistical significance (p=0.105). When the visual analogue scale or Urinary Incontinence Severity Score are used as the outcome measure, the tension-free vaginal tape is more cost-effective than laparoscopic mesh colposuspension over a follow-up period of one year (p<0.000).


CONCLUSIONS
The clinical and economic data of the present study suggest that over a follow-up period of one year the tension-free vaginal tape procedure is more cost-effective than laparoscopic mesh colposuspension as a primary treatment for female stress urinary incontinence.
Valpas
Antti
A
Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Helsinki, Finland. antti.valpas@ekshp.fi
Rissanen
Pekka
P
Kujansuu
Erkki
E
Nilsson
Carl-Gustaf
CG
D003127:Colposcopy / Q000191:economics* / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay; D011183:Postoperative Complications / Q000191:economics / Q000453:epidemiology; D011788:Quality of Life; D013526:Surgical Mesh / Q000191:economics; D053832:Surgical Tape / Q000191:economics; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000191:economics / Q000601:surgery*; D014621:Vagina / Q000601:surgery*