Hostname: page-component-586b7cd67f-dlnhk Total loading time: 0 Render date: 2024-11-26T15:05:42.397Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Department of Health. Hospital in-patient data. Available at: http://www.doh.gov.uk/hes/.
Downs S, Black N. 1996. Systematic review of the literature on the effectiveness of surgery for stress incontinence in women. London: Department of Public Health & Policy Publications, London School of Hygiene & Tropical Medicine; Report no. 21.
Duckett JRA. 1998 The use of periurethral injectables in the treatment of genuine stress incontinence. Br J Obstet Gynaecol. 105: 390– 396.Google Scholar
Foote AJ. 2001 Which is the best minimally invasive procedure? TVT versus laparoscopic colposuspension. Abstract. Proceedings of the 31st Annual Meeting of the International Continence Society, 2001, September 18-21, Seoul, Korea. Abstract no 268.
Glick H, Briggs A, Polsky D. 2001 Quantifying stochastic uncertainty, and presenting results of cost-effectiveness analyses. Expert Rev Pharmacoeconomics Outcomes Res. 1: 25– 36.Google Scholar
Great Britain Office for National Statistics. Statbase. Available at: http://www.doh.gov.uk.
Hunskaar S, Arnold E, Burgio K, et al. 1999. Recommendations of the International Scientific Committee: The evaluation and treatment of urinary incontinence. Epidemiology and natural history of urinary incontinence (UI). 1st International Consultation on Incontinence, 1998. June 28-July 1, Monaco.
Kung RC, Lie K, Lee P, Drutz HP. 1996 The cost-effectiveness of laparoscopic versus abdominal Burch procedures in women with urinary stress incontinence. J Am Assoc Gynecol Laparoscop 3: 537– 544.Google Scholar
Leach GE, Dmochowski RR, Appell RA, et al. 1997 Female stress urinary incontinence clinical guidelines panel summary report on surgical management of female stress urinary incontinence. J Urol. 158: 875– 880.Google Scholar
Lapitan MC, Cody DJ. 2003. Open retropubic colposuspension for urinary stress incontinence in women (Cochrane Review), In: The Cochrane Library, Issue 1, Oxford, Update Software.
Liapis A, Bakas P, Creatsas G. 2002 Burch colposuspension and tension-free vaginal tape in the management of stress urinary incontinence in women. Eur Urol. 41: 469– 473.Google Scholar
Maddern GJ, Middleton PF, Grant A.M. 2002 Urinary stress incontinence. BMJ. 325: 789– 790.Google Scholar
Manca A, Sculpher MJ, Ward K, et al. 2003 A cost-utility analysis of tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence. Br J Obstet Gynaecol. 110: 255– 262.Google Scholar
Lehrer B, Ellis G, Carey M, et al. 2002. Laparoscopic colposuspension for urinary incontinence in women (Cochrane Review) in: The Cochrane Library Issue 2, Oxford, Update Software.
National Institute for Clinical Excellence. Guide to the Methods of Technology Appraisal. Available at: http://www.nice.org.uk.
Ward K, Hilton P, on behalf of the UK & Ireland TVT trial group. 2002 Prospective multicentre randomised trial of tension-free vaginal tape and open colposuspension as primary treatment for stress incontinence. BMJ. 325: 67– 69.17.Google Scholar
Ward KL, Hilton P, Browning J on behalf of the UK and Ireland TVT Trial Group. 2000. Changes in quality of life following surgery with tension free vaginal tape (TVT) or colposuspension for genuine stress incontinence. Abstract. Proceedings of the 3rd Annual Meeting of the International Incontinence Society. August 28-31, Tampere, Finland.
Ward KL, Hilton P, Browning J on behalf of the UK and Ireland TVT Trial Group. 2001 A randomised trial of colposuspension and tension free vaginal tape (TVT) for primary genuine stress incontinence—2 year follow-up. Abstract. Int Urogynecol J Pelvic Floor Dysfunct. 12 (Suppl 3): S7.Google Scholar