title: Economic considerations for mid-urethral sling procedures among patients with stress urinary incontinence.
abstract: BACKGROUND
  Stress urinary incontinence (SUI) is associated with a hefty economic burden. Retropubic and transobturator vaginal slings have become common surgical options for women with SUI. This study examines the costs of transobturator slings for SUI surgeries.
  
  
  METHODS
  A model was created to estimate the budget impact to hospitals of transobturator sling surgery in women with SUI. Current practice using transobturator slings including the MonarcTM Subfascial Hammock, Obtryx® Transobturator Mid-Urethral Sling System, Aris® Transobturator Sling System, Align® TO Trans-Obturator Urethral Support System, GYNECARE TVTTM Obturator System Tension-free Support for Incontinence and GYNECARE TVT ABBREVOTM Continence System were modeled. Four surgical complications were considered: re-operation due to failure, revision or removal of sling, urologic complications including urinary obstruction and urinary tract infection, and pelvic complications. This model calculates the average 1-year cost per patient with the use of each sling product and estimates the total budget for sling urinary incontinence surgery associated with each product based on these calculations.
  
  
  RESULTS
  Average incremental cost over 1 year ranged from $2,601 (GYNECARE TVTTM Obturator) to $3,132 (Desara®) per patient. In a hypothetical population of 100 patients, a 10% shift from the most to the least expensive option was associated with a 2% decrease in hospital expenditures. With the current market share for transobturator sling products, the expected expenditure is around $285,533 for a surgical population of 100 patients. Sling costs account for approximately $105,526 (37%) of this cost, with complications comprising the remaining majority.
  
  
  CONCLUSIONS
  This study represents the first comparative assessment of the costs of different sling options for stress urinary incontinence surgeries. GYNECARE TVT ABBREVOTM and GYNECARE TVTTM Obturator products represent a sound clinical and economic choice for hospitals. Moreover, the reduction in expenditures is obtained at the benefit of patients, who experience fewer complications and avoid complication-related procedures.
authors.affiliation: Johnson & Johnson Global Surgery Group, Somerville, NJ.
authors.forename: Sanjoy
authors.initials: S
authors.lastname: Roy
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Bramley
authors.forename: Piet
authors.initials: P
authors.lastname: Hinoul
authors.forename: Kristen
authors.initials: K
authors.lastname: Migliaccio-Walle
authors.forename: Huimin
authors.initials: H
authors.lastname: Li
mesh_terms: D005260:Female; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D053825:Suburethral Slings / Q000191:economics*; D014550:Urinary Incontinence, Stress / Q000191:economics* / Q000601:surgery*