Surgical treatments for women with stress urinary incontinence: a systematic review of economic evidence

Mehdi Javanbakht, Eoin Moloney*, Miriam Brazzelli, Sheila Wallace, Muhammad Imran Omar, Ash Monga, Lucky Saraswat, Phil Mackie, Mari Imamura, Jemma Hudson, Graeme MacLennan, Luke Vale, Dawn Craig

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)
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Surgical interventions for the treatment of stress urinary incontinence (SUI) in women are commonly employed following the failure of minimally invasive therapies. Due to the limited information available on the relative cost-effectiveness of available surgeries for treating SUI, a de novo economic analysis was conducted to assess costs and effects of all relevant surgeries. To inform the economic analysis, the objective of this review was to identify and assess the quality of existing economic evaluation studies on different surgical interventions for the treatment of SUI in women.

The following databases were searched during the review process: Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process, Excerpta Medica Database (Embase), National Health Service Economic Evaluation Database (NHS EED), and Health Management Information Consortium and Cost-Effectiveness Analysis Registry (CEA registry). The key criteria for inclusion were that the study population included women with SUI and that the surgical interventions considered were utilised as either a primary or a follow-up surgery. The review included only full economic evaluations. Studies were quality assessed using the Drummond checklist for economic evaluations. No quantitative synthesis of the results by meta-analysis was conducted due to the high methodological heterogeneity.

Twenty-six economic evaluations were included, of which 13 were model-based analyses. Surgical treatments assessed most frequently were mid-urethral slings and open and laparoscopic colposuspension. There were some differences in the methodological approaches taken, including differences in type of economic analysis, perspective, time horizon, types of resource use, and costs and outcomes that were included in the analysis. The majority of studies conducted a cost-utility analysis from a health system perspective and applied a time horizon of between 1 and 5 years. The cost-effectiveness results suggest that single-incision mini-sling and mid-urethral slings are among the most cost-effective options.

The review has shown that methods used for the economic evaluation of surgical treatments for SUI vary widely in terms of study design, analysis type, compared alternatives, time horizon, costing methodologies and effect outcomes. Future economic evaluation studies on surgical treatments for SUI may be improved by the application of available guidelines.
Original languageEnglish
Article number85
Number of pages13
JournalSystematic reviews
Publication statusPublished - 20 Apr 2020

Bibliographical note

We would like to acknowledge all those involved in the wider study exploring the effectiveness and cost-effectiveness of surgical treatments for women with stress urinary incontinence.

This research was commissioned by the NIHR HTA Programme as project number 15/09/06. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care, UK. The funders were not actively involved in the research process at any stage. The study design, collection, analysis and interpretation of data, the writing of the manuscript and the decision to submit it for publication were all performed independent of the funders.


  • Systematic review
  • Economic evaluation
  • Surgical treatments
  • Stress urinary incontinence


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