Cost-effectiveness analysis of open colposuspension versus laparoscopic colposuspension in the treatment of urodynamic stress incontinence

J.C. Dumville; A. Manca; H.C. Kitchener; A.R.B. Smith; L. Nelson; D.J. Torgerson

doi:10.1111/j.1471-0528.2006.01036.x

Cost-effectiveness analysis of open colposuspension versus laparoscopic colposuspension in the treatment of urodynamic stress incontinence

J.C. Dumville, A. Manca, H.C. Kitchener, A.R.B. Smith, L. Nelson, D.J. Torgerson

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives To compare the cost effectiveness of laparoscopic versus open colposuspension for the treatment of female urinary stress incontinence.

Design Cost utility analysis alongside a randomised controlled trial.

Setting Six gynaecological surgical centres within the UK.

Population/Sample Women with proven stress urinary incontinence requiring surgery.

Methods Open abdominal retropubic colposuspension or laparoscopic colposuspension carried out by experienced surgeons.

Main outcome measures Cost, measured in pounds sterling and generic health-related quality of life, measured using the EQ-5D. The latter was used to estimate patient-specific quality-adjusted life years (QALYs).

Results Healthcare resource use over 6-month follow up translated into costs of 1805 pound for the laparoscopic arm and 1433 pound for the open arm (differential mean cost 372; pound 95% credibility interval [CrI]: 274-471). At 6 months, QALYs were slightly higher in the laparoscopic arm relative to the open arm (0.005; 95% CrI: -0.012 to 0.023). Therefore, the cost of each extra QALY in the laparoscopic group (the incremental cost-effectiveness ratio [ICER]) was 74,400 pound at 6 months. At 24 months, the laparoscopic arm again had a higher mean QALY score compared to the open surgery group. Thus, assuming that beyond 6 months the laparoscopic colposuspension would not lead to any significant additional costs compared with open colposuspension, the ICER was reduced to 9300 pound at 24 months. Extensive sensitivity analyses were carried out to test assumptions made in the base case scenario.

Conclusions Laparoscopic colposuspension is not cost effective when compared with open colposuspension during the first 6 months following surgery, but it may be cost effective over 24 months.

Original language	English
Pages (from-to)	1014-1022
Number of pages	9
Journal	BJOG: an International Journal of Obstetrics and Gynaecology
Volume	113
Issue number	9
DOIs	https://doi.org/10.1111/j.1471-0528.2006.01036.x
Publication status	Published - Sept 2006

Keywords

colposuspension
cost effectiveness
costs
economics
laparoscopic
open
QALYs
urinary stress incontinence
FREE VAGINAL TAPE
EFFECTIVENESS ACCEPTABILITY CURVES
BURCH COLPOSUSPENSION
RANDOMIZED-TRIAL
URINARY-INCONTINENCE
CLINICAL-TRIAL
MESH
UTILITY
REPAIR
WOMEN

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10.1111/j.1471-0528.2006.01036.x

http://dx.doi.org/10.1111/j.1471-0528.2006.01036.x

Cite this

Dumville, J. C., Manca, A., Kitchener, H. C., Smith, A. R. B., Nelson, L., & Torgerson, D. J. (2006). Cost-effectiveness analysis of open colposuspension versus laparoscopic colposuspension in the treatment of urodynamic stress incontinence. BJOG: an International Journal of Obstetrics and Gynaecology, 113(9), 1014-1022. https://doi.org/10.1111/j.1471-0528.2006.01036.x

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title = "Cost-effectiveness analysis of open colposuspension versus laparoscopic colposuspension in the treatment of urodynamic stress incontinence",

abstract = "Objectives To compare the cost effectiveness of laparoscopic versus open colposuspension for the treatment of female urinary stress incontinence.Design Cost utility analysis alongside a randomised controlled trial.Setting Six gynaecological surgical centres within the UK.Population/Sample Women with proven stress urinary incontinence requiring surgery.Methods Open abdominal retropubic colposuspension or laparoscopic colposuspension carried out by experienced surgeons.Main outcome measures Cost, measured in pounds sterling and generic health-related quality of life, measured using the EQ-5D. The latter was used to estimate patient-specific quality-adjusted life years (QALYs).Results Healthcare resource use over 6-month follow up translated into costs of 1805 pound for the laparoscopic arm and 1433 pound for the open arm (differential mean cost 372; pound 95% credibility interval [CrI]: 274-471). At 6 months, QALYs were slightly higher in the laparoscopic arm relative to the open arm (0.005; 95% CrI: -0.012 to 0.023). Therefore, the cost of each extra QALY in the laparoscopic group (the incremental cost-effectiveness ratio [ICER]) was 74,400 pound at 6 months. At 24 months, the laparoscopic arm again had a higher mean QALY score compared to the open surgery group. Thus, assuming that beyond 6 months the laparoscopic colposuspension would not lead to any significant additional costs compared with open colposuspension, the ICER was reduced to 9300 pound at 24 months. Extensive sensitivity analyses were carried out to test assumptions made in the base case scenario.Conclusions Laparoscopic colposuspension is not cost effective when compared with open colposuspension during the first 6 months following surgery, but it may be cost effective over 24 months.",

keywords = "colposuspension, cost effectiveness, costs, economics, laparoscopic, open, QALYs, urinary stress incontinence, FREE VAGINAL TAPE, EFFECTIVENESS ACCEPTABILITY CURVES, BURCH COLPOSUSPENSION, RANDOMIZED-TRIAL, URINARY-INCONTINENCE, CLINICAL-TRIAL, MESH, UTILITY, REPAIR, WOMEN",

author = "J.C. Dumville and A. Manca and H.C. Kitchener and A.R.B. Smith and L. Nelson and D.J. Torgerson",

year = "2006",

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doi = "10.1111/j.1471-0528.2006.01036.x",

language = "English",

volume = "113",

pages = "1014--1022",

journal = "BJOG: an International Journal of Obstetrics and Gynaecology",

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TY - JOUR

T1 - Cost-effectiveness analysis of open colposuspension versus laparoscopic colposuspension in the treatment of urodynamic stress incontinence

AU - Dumville, J.C.

AU - Manca, A.

AU - Kitchener, H.C.

AU - Smith, A.R.B.

AU - Nelson, L.

AU - Torgerson, D.J.

PY - 2006/9

Y1 - 2006/9

N2 - Objectives To compare the cost effectiveness of laparoscopic versus open colposuspension for the treatment of female urinary stress incontinence.Design Cost utility analysis alongside a randomised controlled trial.Setting Six gynaecological surgical centres within the UK.Population/Sample Women with proven stress urinary incontinence requiring surgery.Methods Open abdominal retropubic colposuspension or laparoscopic colposuspension carried out by experienced surgeons.Main outcome measures Cost, measured in pounds sterling and generic health-related quality of life, measured using the EQ-5D. The latter was used to estimate patient-specific quality-adjusted life years (QALYs).Results Healthcare resource use over 6-month follow up translated into costs of 1805 pound for the laparoscopic arm and 1433 pound for the open arm (differential mean cost 372; pound 95% credibility interval [CrI]: 274-471). At 6 months, QALYs were slightly higher in the laparoscopic arm relative to the open arm (0.005; 95% CrI: -0.012 to 0.023). Therefore, the cost of each extra QALY in the laparoscopic group (the incremental cost-effectiveness ratio [ICER]) was 74,400 pound at 6 months. At 24 months, the laparoscopic arm again had a higher mean QALY score compared to the open surgery group. Thus, assuming that beyond 6 months the laparoscopic colposuspension would not lead to any significant additional costs compared with open colposuspension, the ICER was reduced to 9300 pound at 24 months. Extensive sensitivity analyses were carried out to test assumptions made in the base case scenario.Conclusions Laparoscopic colposuspension is not cost effective when compared with open colposuspension during the first 6 months following surgery, but it may be cost effective over 24 months.

AB - Objectives To compare the cost effectiveness of laparoscopic versus open colposuspension for the treatment of female urinary stress incontinence.Design Cost utility analysis alongside a randomised controlled trial.Setting Six gynaecological surgical centres within the UK.Population/Sample Women with proven stress urinary incontinence requiring surgery.Methods Open abdominal retropubic colposuspension or laparoscopic colposuspension carried out by experienced surgeons.Main outcome measures Cost, measured in pounds sterling and generic health-related quality of life, measured using the EQ-5D. The latter was used to estimate patient-specific quality-adjusted life years (QALYs).Results Healthcare resource use over 6-month follow up translated into costs of 1805 pound for the laparoscopic arm and 1433 pound for the open arm (differential mean cost 372; pound 95% credibility interval [CrI]: 274-471). At 6 months, QALYs were slightly higher in the laparoscopic arm relative to the open arm (0.005; 95% CrI: -0.012 to 0.023). Therefore, the cost of each extra QALY in the laparoscopic group (the incremental cost-effectiveness ratio [ICER]) was 74,400 pound at 6 months. At 24 months, the laparoscopic arm again had a higher mean QALY score compared to the open surgery group. Thus, assuming that beyond 6 months the laparoscopic colposuspension would not lead to any significant additional costs compared with open colposuspension, the ICER was reduced to 9300 pound at 24 months. Extensive sensitivity analyses were carried out to test assumptions made in the base case scenario.Conclusions Laparoscopic colposuspension is not cost effective when compared with open colposuspension during the first 6 months following surgery, but it may be cost effective over 24 months.

KW - colposuspension

KW - cost effectiveness

KW - costs

KW - economics

KW - laparoscopic

KW - open

KW - QALYs

KW - urinary stress incontinence

KW - FREE VAGINAL TAPE

KW - EFFECTIVENESS ACCEPTABILITY CURVES

KW - BURCH COLPOSUSPENSION

KW - RANDOMIZED-TRIAL

KW - URINARY-INCONTINENCE

KW - CLINICAL-TRIAL

KW - MESH

KW - UTILITY

KW - REPAIR

KW - WOMEN

U2 - 10.1111/j.1471-0528.2006.01036.x

DO - 10.1111/j.1471-0528.2006.01036.x

M3 - Article

SN - 1470-0328

VL - 113

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EP - 1022

JO - BJOG: an International Journal of Obstetrics and Gynaecology

JF - BJOG: an International Journal of Obstetrics and Gynaecology

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