Open Access

ARTICLE

Surgery versus collagen for female stress urinary incontinence: economic assessment in Ontario and Quebec

Mark Oremus^1,2, Jean-Paul Collet^1,2,3, Stanley H. Shapiro^1,2, John Penrod^4,5, Jacques Corcos^6,7

1 Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
2 Joint Departments of Epidemiology and Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada
3 Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
4 Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada
5 Department of Economics, McGill University, Montreal, Quebec, Canada
6 Division of Urology, Jewish General Hospital, Montreal, Quebec, Canada
7 Faculty of Medicine, McGill University, Montreal, Quebec, Canada
Address correspondence to Mr. Mark Oremus, Centre for Clinical Epidemiology and Community Studies, Jewish General Hospital – Room A-121, 3755 Cote Ste.-Catherine Road, Montreal, Quebec H3T 1E2 Canada

Canadian Journal of Urology 2003, 10(4), 1934-1944.

Abstract

Introduction and objective: The purpose of this study was to evaluate the cost-effectiveness of surgery versus collagen injection to treat female stress urinary incontinence after the failure of initial surgical treatment. The analysis was conducted from the health care system perspectives of Ontario and Quebec.
Materials and methods: A decision-tree was constructed to compare each of three surgeries (i.e., retropubic suspension, transvaginal suspension, sling procedures) with collagen. An average cost estimate was generated for each intervention, as was an incremental cost-effectiveness ratio for each surgery-collagen comparison.
Results: In both Ontario and Quebec, the treatment with the lowest average cost was collagen (Ontario: collagen = $2695; Quebec: collagen = $2718). However, the surgeries had higher probabilities of success (defined as 'cure' – no urine leakage during follow-up examinations), with point estimates of at least .79 (.53 for collagen). Incremental cost-effectiveness ratios for the base case analyses of all treatment comparisons indicated that the cost to cure an additional patient with surgery could range from $1824 to $6814 in Ontario and $1388 to $3008 in Quebec. These ratios were sensitive to changes in the mean number of injections for collagen patients and to a reduction in the length of hospital stay for surgery to 1 day.
Conclusions: Collagen injection may be cost-effective as a follow-up treatment to initial surgical failure in both Ontario and Quebec when the number of injections is kept to a minimum and hospital stays after surgery are relatively lengthy. Otherwise, surgery may be cost-effective.

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