Surgical treatments for women with stress urinary incontinence: a systematic review of economic evidence

Mehdi Javanbakht, Eoin Moloney*, Miriam Brazzelli, Sheila Wallace, Muhammad Imran Omar, Ash Monga, Lucky Saraswat, Phil Mackie, Mari Imamura, Jemma Hudson, Graeme MacLennan, Luke Vale, Dawn Craig

*Corresponding author for this work

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Abstract

Background
Surgical interventions for the treatment of stress urinary incontinence (SUI) in women are commonly employed following the failure of minimally invasive therapies. Due to the limited information available on the relative cost-effectiveness of available surgeries for treating SUI, a de novo economic analysis was conducted to assess costs and effects of all relevant surgeries. To inform the economic analysis, the objective of this review was to identify and assess the quality of existing economic evaluation studies on different surgical interventions for the treatment of SUI in women.

Methods
The following databases were searched during the review process: Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process, Excerpta Medica Database (Embase), National Health Service Economic Evaluation Database (NHS EED), and Health Management Information Consortium and Cost-Effectiveness Analysis Registry (CEA registry). The key criteria for inclusion were that the study population included women with SUI and that the surgical interventions considered were utilised as either a primary or a follow-up surgery. The review included only full economic evaluations. Studies were quality assessed using the Drummond checklist for economic evaluations. No quantitative synthesis of the results by meta-analysis was conducted due to the high methodological heterogeneity.

Results
Twenty-six economic evaluations were included, of which 13 were model-based analyses. Surgical treatments assessed most frequently were mid-urethral slings and open and laparoscopic colposuspension. There were some differences in the methodological approaches taken, including differences in type of economic analysis, perspective, time horizon, types of resource use, and costs and outcomes that were included in the analysis. The majority of studies conducted a cost-utility analysis from a health system perspective and applied a time horizon of between 1 and 5 years. The cost-effectiveness results suggest that single-incision mini-sling and mid-urethral slings are among the most cost-effective options.

Conclusions
The review has shown that methods used for the economic evaluation of surgical treatments for SUI vary widely in terms of study design, analysis type, compared alternatives, time horizon, costing methodologies and effect outcomes. Future economic evaluation studies on surgical treatments for SUI may be improved by the application of available guidelines.
Original languageEnglish
Article number85
Number of pages13
JournalSystematic reviews
Volume9
DOIs
Publication statusPublished - 20 Apr 2020

Keywords

  • Systematic review
  • Economic evaluation
  • Surgical treatments
  • Stress urinary incontinence
  • COST-EFFECTIVENESS ANALYSIS
  • OBTURATOR
  • UTILITY ANALYSIS
  • MANAGEMENT
  • BURCH COLPOSUSPENSION
  • FREE VAGINAL TAPE
  • LAPAROSCOPIC COLPOSUSPENSION

ASJC Scopus subject areas

  • Medicine (miscellaneous)

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