Trans-obturator tape compared with tension-free vaginal tape in the surgical treatment of stress urinary incontinence: a cost utility analysis

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.