Surgical treatment of stress urinary incontinence - trans-obturator tape compared with tension-free vaginal tape-5-year follow up: an economic evaluation

Objective To conduct an economic evaluation of the use of transobturator tape (TOT) compared with tension-free vaginal tape (TVT) in the surgical treatment of stress urinary incontinence in women. Design Cost-utility and cost-effectiveness analyses from a publicpayer perspective, conducted alongside a randomised clinical trial. Setting Health services provided in Alberta, Canada. Sample 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. Main outcome measures 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. Conclusion The results suggest that TOT is cost-effective compared with TVT in the treatment of stress urinary incontinence.