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Cost effectiveness of tension-free vaginal tape for the surgical management of female stress incontinence

Published online by Cambridge University Press:  01 November 2004

Mary Kilonzo ,
Luke Vale ,
Sally C. Stearns ,
Adrian Grant ,
June Cody ,
Cathryn M. A. Glazener ,
Sheila Wallace  and
Kirsty McCormack
Mary Kilonzo
Affiliation:
University of Aberdeen
Luke Vale
Affiliation:
University of Aberdeen
Sally C. Stearns
Affiliation:
University of Aberdeen University of North Carolina at Chapel Hill
Adrian Grant
Affiliation:
University of Aberdeen
June Cody
Affiliation:
University of Aberdeen
Cathryn M. A. Glazener
Affiliation:
University of Aberdeen
Sheila Wallace
Affiliation:
University of Aberdeen
Kirsty McCormack
Affiliation:
University of Aberdeen
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Abstract

Objectives: Stress urinary incontinence affects between 10 percent and 50 percent of women. Surgery is commonly recommended for troublesome incontinence that does not respond to nonsurgical management. Tension-free vaginal tape (TVT) is a newer, minimal access surgical sling procedure, which is being increasingly adopted worldwide. The cost-effectiveness of TVT in comparison with other surgical procedures, particularly open colposuspension, is assessed.

Methods: Effectiveness estimates came from a systematic review of TVT compared with other surgical procedures (open and laparoscopic colposuspension, traditional slings, and injectables). Deterministic and probabilistic analyses were used to assess the likelihood of TVT being cost-effective. Sensitivity analyses assessed the impact of changing assumptions about cure rates and costs for TVT, cure rates for retreatment open colposuspension, and proportions of women who choose retreatment.

Results: Reliable estimates of relative effectiveness were difficult to derive because the few randomized controlled comparisons had not been optimally analyzed or fully reported. Results of the economic model suggested that TVT dominates open colposuspension (lower cost and same quality of life years[QALYs]) within 5 years after surgery. Stochastic analysis indicated that the likelihood of TVT being cost-effective was 100 percent if decision-makers are unwilling to pay for additional QALYs. TVT's dominance depended on the assumption fact that retreatment open colposuspension has lower cure rates than a first colposuspension.

Conclusions: Analysis based on current short-term data indicates dominance of TVT over open colposuspension from approximately 5 years. There is a need for longer-term follow-up data from methodologically rigorous randomized trials to provide a sounder basis for estimating the relative benefits and cost implications.

Keywords

Tension-free vaginal tapeIncontinenceEconomic evaluationCost-effectiveness
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 4 , November 2004 , pp. 455 - 463
Copyright
© 2004 Cambridge University Press

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