Cost‐analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension‐free vaginal tape procedure

Abstract

Cost-analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension-free vaginal tape procedure.Persson, Jan; Teleman, Pia; Etén-Bergquist, Christina; Wölner-Hanssen, PålPublished in: Acta Obstetricia et Gynecologica Scandinavica DOI: 10.1034/j. 1600 -0412.2002 .811112.x Published: 2002 Link to publication Citation for published version (APA): Persson, J., Teleman, P., Etén-Bergquist, C., & Wölner-Hanssen, P. (2002). Cost-analyzes based on a prospective, randomized study comparing laparoscopic colposuspension with a tension-free vaginal tape procedure. Acta Obstetricia et Gynecologica Scandinavica, 81(11), 1066-1073. DOI: 10.1034/j.1600-0412.2002 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Background. The aim of this study was to compare laparoscopic colposuspension with tension-free vaginal tape (TVT) in terms of costs to the county. Methods. In a prospective, randomized study, we approached 270 consecutive women presenting for evaluation of stress urinary incontinence symptoms at one university hospital. Preoperatively, and at 1-year follow-up, the women underwent urodynamic evaluation, an ultra-short pad-test and completed a lower urinary tract symptoms questionnaire. We randomized 79 consenting, eligible women to either procedure; a 1-year follow-up examination was performed on 68/71 (96%) women that were available. The procedures were performed as described previously. Main outcome measures were all relevant costs for goods and services associated with the procedures. Results. The baseline characteristics of the two groups were similar. The TVT procedure was performed significantly faster than the laparoscopic colposuspension, i.e. 44.9 ∫ 14.2 min compared with 60.5 ∫ 13.4 min (p Ͻ 0.0001). Even so, procedural costs were significantly lower for laparoscopic colposuspension than for TVT (s 1273.4 compared with s 1342.8 p Ͻ 0.001). At the 1-year follow-up visit, three women operated on with TVT and one operated on with laparoscopic colposuspension required re-operation for continuous stress urinary incontinence. One women operated on with TVT had her sling cut for bladder-emptying problems. Total costs, including re-operations were s 1462.6 for a TVT procedure and s 1314.5 for a laparoscopic colposuspension. Conclusion. In our hands, the laparoscopic colposuspension was less expensive to the county than the TVT procedure.

Laparoscopic treatment of urinary incontinence

“…Ultimately, the deciding factor may be cost. One cost-analysis study comparing the two procedures suggested that overall costs are lower with the laparoscopic Burch procedure [55].…”

Which sling for stress urinary incontinence?

“…From these studies, it is apparent that TVT has a much better costbenefit ratio than the Burch colposuspension. However, a laparoscopic Burch colposuspension was slightly cheaper in one study, which may be due to the health financing system in Sweden [62]. In a Dutch study comparing all costs of several treatments for SUI, it was shown that the least expensive treatment was physiotherapy, followed by TVT [63].…”

Preoperative urethral parameters at rest and objective cure following laparoscopic colposuspension

“…In addition, for the last two studies [18,19] a urethral functional length of 25 mm or more was required. The exclusion criteria were symptomatic urge incontinence, urodynamicaly demonstrable detrusor instability, previous incontinence or prolapse surgery or a vaginal descent more than grade one cystocele according to Beecham's classification [20] The preoperative investigation was performed by a restricted number of physicians (n=4) and included demographic and contraceptive history, urodynamics, gynaecological investigation, measurement of residual urine, cystoscopy and a standardized short term pad-test [21].…”

“…3: a prospective randomized study comparing costs between laparoscopic colposuspension and the TVT procedure [17][18][19], the latter being a part of a larger currently ongoing study (study nr 4) comparing clinical outcome for these two procedures.…”