Cost Effectiveness analysis of Surgical Treatment of Stress Urinary Incontinence Using Single-Incision Mini-Slings vs. Tension-Free Vaginal Obturator in Spain

Abstract

Objectives: Stress Urinary Incontinence (SUI) is highly prevalent, noticeably deteriorating quality of life. The current surgical treatment is performed through minimally invasive techniques that are quite rapidly evolving. The objective of this study is to analyze the comparative efficiency, from the perspective of the health system, of surgical treatments for patients with SUI through the use of the single-incision mini-sling (SIMS), MiniArc™ (American Medical Systems, Inc), in relation to the transobturator sling, TVT-O.
Methods: Cost-effectiveness analysis based on the results of interventions performed with TVT-O (2005-2008) and MiniArc™ (2008-2011) in women with a diagnosis of SUI. The clinical result was an objective cure at 12 months (pad-test <1 g/h). The costs were the direct healthcare costs (diagnostic and surgical procedures, medical devices, medications, hospital stay times and staff). Later, different sensitivity analyses were conducted.
Results: The two groups were homogenous regarding the principal base characteristics. No statistically significant difference in effectiveness between MiniArc™ (93.2%) and TVT-O (86.5%) was observed. The total annual cost per patient was less with MiniArc™ (2,059€, 95% CI: 1,914; 2,285; 2,543$, 95% CI: 2,364; 2,822) than with TVT-O (2,821€, 95% CI: 2,661; 2,997; 3,484$, 95% CI: 3,287; 3,701), causing an estimated savings of 762€, 95% CI: 516; 987 (-941$, 95% CI: -1,219; -637). The sensitivity analysis showed that the probability of association MiniArc™ with the lowest cost was close to 100% in almost all the cases.
Conclusions: The use of MiniArc™ is associated with a 762€, 941$ per patient reduction in the average annual cost, compared to TVT-O, while maintaining a similar effectiveness.