title: Cost-effectiveness analysis of tension-free vaginal tape vs burch colposuspension for female stress urinary incontinence in the USA.
abstract: OBJECTIVE
  To compare the cost-effectiveness (CE) of tension-free vaginal tape (TVT) with that of burch colposuspension (BC) for the treatment of female stress urinary incontinence (SUI).
  
  
  METHODS
  A Markov-chain decision model was created to simulate treatment of SUI with TVT or BC using Treeage Pro 2011 software (Treeage Software Inc., Williamstown, MA, USA). Costing data were obtained from the Medicare Resource-Based Relative Value Scale. Data regarding the success of TVT vs BC were obtained from the peer-reviewed literature, as were corresponding utilities for different continence states. The CE of each procedure was calculated and compared, and sensitivity analyses were performed.
  
  
  RESULTS
  At 10-year follow-up, TVT was more cost-effective (CE = $1495/quality-adjusted life year [QALY]) than BC (CE = $1824/QALY). Sensitivity analysis showed that TVT was more cost-effective than BC if the cost of the TVT device was <$3220. If the probability of success after TVT was <42%, then BC became the more cost-effective strategy (CE = $1827/QALY).
  
  
  CONCLUSIONS
  Our study showed that TVT was more cost-effective than BC as a treatment for female SUI. Both cost of TVT device and efficacy of the procedure affect the CE analysis.
authors.affiliation: Department of Urology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, NY 10065, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Laudano
authors.forename: Stephan
authors.initials: S
authors.lastname: Seklehner
authors.forename: Bilal
authors.initials: B
authors.lastname: Chughtai
authors.forename: Una
authors.initials: U
authors.lastname: Lee
authors.forename: Renuka
authors.initials: R
authors.lastname: Tyagi
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kavaler
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Te
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kaplan
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008390:Markov Chains; D012680:Sensitivity and Specificity; D053825:Suburethral Slings / Q000191:economics*; D014481:United States; D014550:Urinary Incontinence, Stress / Q000191:economics* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000191:economics / Q000379:methods