title: Trans-obturator tape compared with tension-free vaginal tape in the surgical treatment of stress urinary incontinence: a cost utility analysis.
abstract: OBJECTIVE
  To conduct an economic evaluation of the use of trans-obturator tape (TOT) compared with tension-free vaginal tape (TVT) in the surgical treatment of stress urinary incontinence (SUI) in women.
  
  
  METHODS
  Cost utility analysis from public-payer perspective, conducted alongside a randomised clinical trial (RCT).
  
  
  METHODS
  Health services provided in Alberta, Canada.
  
  
  METHODS
  A total of 194 women who participated in the RCT, followed to 1 year from surgery.
  
  
  METHODS
  Data collected on all women in the RCT, over 12 months following surgery. Comparisons undertaken between RCT groups for cost and quality-adjusted life-years (QALYs). Multiple imputation used for the 10% missing data. Bootstrapping used to account for sampling uncertainty. One-way sensitivity analysis conducted for productivity loss due to time away from work.
  
  
  METHODS
  Utility--15D questionnaire was used to calculate QALYs. Costs over 12 months--from trial data, health provider and provincial ministry of health.
  
  
  RESULTS
  The TOT group had a non-significant average saving of $1133 (95% CI -2793; 442), with no difference in average QALYs between groups (95% CI -0.02; 0.01). TOT was cost-saving in over 80% of bootstrapping replications, over a wide range of willingness-to-pay.
  
  
  CONCLUSIONS
  The bootstrapping replication results suggest that TOT could be cost-effective compared with TVT in the treatment of SUI. However, these results must be confirmed by longer-term assessment of clinical and economic outcomes, because of concern that surgical tape palpable at 12 months may lead to vaginal erosion and further treatment.
authors.affiliation: Institute of Health Economics, Edmonton, Alberta, Canada.
authors.forename: D
authors.initials: D
authors.lastname: Lier
authors.forename: S
authors.initials: S
authors.lastname: Ross
authors.forename: S
authors.initials: S
authors.lastname: Tang
authors.forename: M
authors.initials: M
authors.lastname: Robert
authors.forename: P
authors.initials: P
authors.lastname: Jacobs
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011182:Postoperative Care / Q000706:statistics & numerical data; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D053825:Suburethral Slings / Q000191:economics*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000191:economics / Q000601:surgery*