title: Surgical treatment of stress urinary incontinence-trans-obturator tape compared with tension-free vaginal tape-5-year follow up: an economic evaluation.
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 in women.
  
  
  METHODS
  Cost-utility and cost-effectiveness analyses from a public-payer perspective, conducted alongside a randomised clinical trial.
  
  
  METHODS
  Health services provided in Alberta, Canada.
  
  
  METHODS
  A total of 195 women participated in the randomised clinical trial, followed to 5 years postsurgery.
  
  
  METHODS
  Comparisons were undertaken between study groups for cost and two health-outcome measures. Multiple imputation was used to estimate the 14% of missing data. Bootstrapping was used to account for sampling uncertainty. Sensitivity analyses were based on complete case analyses and the removal of a TVT patient with extreme health service cost.
  
  
  METHODS
  The 15D instrument was used to calculate quality-adjusted life-years (QALYs) for the primary analysis. Absence of serious adverse events was also analysed. Costs were based on inpatient and outpatient hospital use data and practitioner fee-for-service claims data.
  
  
  RESULTS
  The TOT group had a nonsignificant average saving of $2368 (95% CI -$7166 to $2548) and incremental gain of 0.04 QALYs (95% CI -0.06 to 0.14) compared with TVT. TOT was dominant in over 71% of bootstrap replications and cost-effective over a wide range of willingness-to-pay. Cost-effectiveness analysis using the absence of an serious adverse events provided similar results.
  
  
  CONCLUSIONS
  The results suggest that TOT is cost-effective compared with TVT in the treatment of stress urinary incontinence.
  
  
  CONCLUSIONS
  The results of a 5-year cost-effectiveness analysis suggest that trans-obturator tape is cost-effective compared with tension-free vaginal tape in the treatment of stress urinary incontinence.
authors: Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.
authors: D
authors: D
authors: Lier
authors: Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.
authors: M
authors: M
authors: Robert
authors: Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.
authors: S
authors: S
authors: Tang
authors: Department of Obstetrics and Gynecology, University of Alberta, Edmonton, AB, Canada.|Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.
authors: S
authors: S
authors: Ross
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D053825:Suburethral Slings / Q000191:economics*; D016896:Treatment Outcome; D014550:Urinary Incontinence, Stress / Q000191:economics / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000191:economics / Q000295:instrumentation* / Q000379:methods
keywords: Cost; cost utility; cost-effectiveness; stress/surgery; suburethral slings; treatment outcome; urinary incontinence