Many SUI studies lack long-term follow-up

Montreal-Economic analyses of surgeries to treat stress urinary incontinence (SUI) do not routinely include long-term follow-up of patients, nor do they routinely capture long-term complications, researchers say.

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Philippe E. Zimmern MD, of the University of Texas Southwestern Medical Center in Dallas, noted the lifetime risk of a procedure for SUI is 13.6% (Obstet Gynecology 2014; 123:1201-6), and if the efficacy of the procedure proves to be short-lived, the ongoing management of SUI becomes costly to a country's health care system.

"There is the upfront cost of a procedure, and there is long-term cost or re-treatment cost. Many papers don't contain information about the long-term costs or re-treatments costs. Many of the papers included RCTs (randomized, controlled trials) with short follow-up. We can't assume that what happens at 24 months will remain so at 10 years," said Dr. Zimmern.

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"If you do an operation that stands the test of time, then it is cost-effective," he said in an interview with Urology Times. "If patients remain dry and don't have complications, then it is worth doing the operation. If patients have to be re-operated a few years later, for example, it may not be cost-effective."

Next: Standard reporting recommendations need to be followed

Dr. Zimmern put forth that standard reporting recommendations need to be followed to have complete reporting of methods and findings and allow for an "apples to apples" comparison of the cost-effectiveness of SUI surgical procedures.

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The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement includes a checklist of items to include when reporting economic evaluations of health interventions, with some of those items being any assumptions in a model, characterizing any uncertainty in sampling, incremental costs and outcomes, the target population, and any analysis of subgroups (BMC Medicine 2013; 11:80). Dr. Zimmern and co-author Tanner Rawlings used this checklist to evaluate the studies included in their analysis.

With the prediction that the burden of SUI management will become greater in the coming years, SUI management will become increasingly costly, said Dr. Zimmern. Indeed, the total number of women who are expected to undergo SUI will rise 47.2% from 210,700 in 2010 to 310,050 in 2050 (Am J Obstet Gynecol 2011; 205:230).

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Dr. Zimmern and Rawlings conducted a MEDLINE search covering papers published on economic analysis of surgical procedures to correct SUI from 2000 to 2014. Among 13 articles meeting their search criteria, three came from the U.S., four from the United Kingdom, two from Canada, and four from continental Europe. Seven of the analyses included follow-up of more than 1 year, one included more than 6 months’ follow-up, and four included more than 24 months’ follow-up.

Next: Eleven studies integrated indirect costs

Eleven studies integrated indirect costs but two did not, said Dr. Zimmern. Indirect costs referred to treatment of complications, readmission to hospital, retreatment for incontinence, time away from work, and erosion of a sling. Only three specifically incorporated sling erosion as a potential complication of SUI surgery, six analyses included the cost of complications, eight included the cost of re-admission, and five analyses incorporated re-treatment costs, noted Dr. Zimmern.

Dr. Zimmern said there is hope that all articles on this topic will cover the CHEERS checklist, so that reports can be more accurately compared to each other. This, along with more long-term reports, will improve the knowledge about cost related to surgical procedures to correct SUI.

The study was presented at the International Continence Society annual meeting in Montreal.

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