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. DESIGN: Cost utility analysis from public-payer perspective, conducted alongside a randomised clinical trial (RCT). SETTING: Health services provided in Alberta, Canada. POPULATION: 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. MAIN OUTCOME MEASURES: 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. CONCLUSION: 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.
RCT Entities:
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. DESIGN: Cost utility analysis from public-payer perspective, conducted alongside a randomised clinical trial (RCT). SETTING: Health services provided in Alberta, Canada. POPULATION: 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. MAIN OUTCOME MEASURES: 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. CONCLUSION: 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: Jerry G Blaivas; Rajveer S Purohit; Matthew S Benedon; Gabriel Mekel; Michael Stern; Mubashir Billah; Kola Olugbade; Robert Bendavid; Vladimir Iakovlev Journal: Nat Rev Urol Date: 2015-08-18 Impact factor: 14.432
Authors: Claudia Cristina Palos; Ana P Maturana; Frederico R Ghersel; Cesar E Fernandes; Emerson Oliveira Journal: Int Urogynecol J Date: 2017-10-02 Impact factor: 2.894
Authors: Mehdi Javanbakht; Eoin Moloney; Miriam Brazzelli; Sheila Wallace; Muhammad Imran Omar; Ash Monga; Lucky Saraswat; Phil Mackie; Mari Imamura; Jemma Hudson; Michal Shimonovich; Graeme MacLennan; Luke Vale; Dawn Craig Journal: Syst Rev Date: 2020-04-20