Heterogeneity of cost estimates in health economic evaluation research. A systematic review of stress urinary incontinence studies

Introduction and hypothesisThere is increased demand for an international overview of cost estimates and insight into the variation affecting these estimates. Understanding of these costs is useful for cost-effectiveness analysis (CEA) research into new treatment modalities and for clinical guideline development.MethodsA systematic search was conducted in Ovid MEDLINE & other non-indexed materials and Ovid Embase for articles published between 1995 and 2017. The National Health Service Economic Evaluation Database (NHS-EED) filter and the McMaster sensitive therapy filter were combined with a bespoke search strategy for stress urinary incontinence (SUI). We extracted unit cost estimates, assessed variability and methodology, and determined transferability.ResultsWe included 37 studies in this review. Four hundred and eighty-two cost estimates from 13 countries worldwide were extracted. Descriptive analysis shows that hospital stay in gynecology ranged between Euro82 and Euro1,292 per day. Costs of gynecological consultation range from Euro30 in France to Euro158 in Sweden. In the UK, costs are estimated at Euro228 per hour. Costs of a tension-free vaginal tape (TVT) device range from Euro431 in Finland to Euro994 in Canada. TVT surgery per minute costs Euro25 in France and Euro82 in Sweden. Total costs of TVT range from Euro1,224 in Ireland to Euro5,809 for inpatient care in France. Variation was explored.ConclusionsHeterogeneity was observed in cost estimates for all units at all levels of health care. CEAs of SUI interventions cannot be interpreted without bias when the base of these analysesnamely costscannot be compared and generalized.