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

Mary Kilonzo, Luke Vale, Sally C. Stearns, Adrian Grant, June Cody, Cathryn M. A. Glazener, Sheila Wallace, Kirsty McCormack

Research output: Contribution to journalArticle

29 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)455-463
Number of pages9
JournalInternational Journal of Technology Assessment in Health Care
Volume20
Issue number4
DOIs
Publication statusPublished - Nov 2004

Keywords

  • tension-free vaginal tape
  • incontinence
  • economic evaluation
  • cost-effectiveness
  • urinary-incontinence
  • colposuspension
  • women

Cite this

Cost effectiveness of tension-free vaginal tape for the surgical management of female stress incontinence. / Kilonzo, Mary; Vale, Luke; Stearns, Sally C.; Grant, Adrian; Cody, June; Glazener, Cathryn M. A.; Wallace, Sheila; McCormack, Kirsty.

In: International Journal of Technology Assessment in Health Care, Vol. 20, No. 4, 11.2004, p. 455-463.

Research output: Contribution to journalArticle

@article{ca763d750ae44130a966aa1ed1835a0a,
title = "Cost effectiveness of tension-free vaginal tape for the surgical management of female stress incontinence",
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 tape, incontinence, economic evaluation, cost-effectiveness, urinary-incontinence, colposuspension, women",
author = "Mary Kilonzo and Luke Vale and Stearns, {Sally C.} and Adrian Grant and June Cody and Glazener, {Cathryn M. A.} and Sheila Wallace and Kirsty McCormack",
year = "2004",
month = "11",
doi = "10.1017/S0266462304001357",
language = "English",
volume = "20",
pages = "455--463",
journal = "International Journal of Technology Assessment in Health Care",
issn = "0266-4623",
publisher = "Cambridge University Press",
number = "4",

}

TY - JOUR

T1 - Cost effectiveness of tension-free vaginal tape for the surgical management of female stress incontinence

AU - Kilonzo, Mary

AU - Vale, Luke

AU - Stearns, Sally C.

AU - Grant, Adrian

AU - Cody, June

AU - Glazener, Cathryn M. A.

AU - Wallace, Sheila

AU - McCormack, Kirsty

PY - 2004/11

Y1 - 2004/11

N2 - 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.

AB - 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.

KW - tension-free vaginal tape

KW - incontinence

KW - economic evaluation

KW - cost-effectiveness

KW - urinary-incontinence

KW - colposuspension

KW - women

U2 - 10.1017/S0266462304001357

DO - 10.1017/S0266462304001357

M3 - Article

VL - 20

SP - 455

EP - 463

JO - International Journal of Technology Assessment in Health Care

JF - International Journal of Technology Assessment in Health Care

SN - 0266-4623

IS - 4

ER -