Is Burch colposuspension ever cost-effective compared with tension-free vaginal tape for stress incontinence?
OBJECTIVE
This study was undertaken to evaluate the cost-effectiveness of Burch colposuspension compared with tension-free vaginal tape.


METHODS
A Markov decision model was developed to compare costs (2005 US dollars) and effectiveness (quality-adjusted life years) of Burch and tension-free vaginal tape for stress urinary incontinence over 10 years from a health care system perspective. After surgery, outcomes included cure, persistent stress urinary incontinence followed by second surgery, and persistent stress urinary incontinence and mesh erosion after tension-free vaginal tape. An incremental cost-effectiveness ratio of less than $50,000 per quality-adjusted life year was considered cost-effective.


RESULTS
For the base-case, the Burch strategy cost more than tension-free vaginal tape ($9320 vs $8081), but was slightly more effective (7.260 vs 7.248 quality-adjusted life years). The incremental cost-effectiveness ratio was $98,755 per quality-adjusted life year. The incremental cost-effectiveness ratio was less than $50,000 per quality-adjusted life year when the relative risk of cure after Burch to tension-free vaginal tape was greater than 1.09.


CONCLUSIONS
Burch colposuspension was not cost-effective compared with tension-free vaginal tape. However, if the tension-free vaginal tape failure rate was to increase over time, Burch may become cost-effective.
Wu
Jennifer M
JM
Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
Visco
Anthony G
AG
Weidner
Alison C
AC
Myers
Evan R
ER
D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D053825:Suburethral Slings / Q000191:economics*; D013526:Surgical Mesh / Q000191:economics; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000191:economics* / Q000601:surgery; D013519:Urogenital Surgical Procedures / Q000191:economics* / Q000379:methods