THE COST-EFFECTIVENESS OF LAPAROSCOPIC VERSUS ABDOMINAL BURCH PROCEDURES IN WOMEN WITH URINARY STRESS-INCONTINENCE

Study Objective. To evaluate the cost-effectiveness of laparoscopic ve rsus abdominal Burch procedures in women with urinary stress incontine nce (USI). Design. A historical cohort with a minimum follow-up of 1 y ear. Setting. Two tertiary, university-affiliate referral centers. Pat ients. Women with USI who had either a laparoscopic Burch (31 women) o r an abdominal Burch procedure (31). They were matched for the type of procedure as well as any concurrent procedures. Measurements and Main Results. The primary outcome was cure, defined as the absence of USI subjectively as described by the patient, and objectively as confirmed by urodynamic and stress tests. Cost data were extracted from hospita l charts and office records. To calculate costs we assessed profession al fees (physicians, nurses, nursing assistants), investigations (labo ratory tests, radiology, urodynamics), drugs, capital equipment, dispo sable equipment, and length of stay. The cure rates were 97% and 90%, respectively. The mean duration of follow-up was 1.2 years (range 1-2. 5 yrs) for a laparoscopic Burch and 2.7 years (range 1-9 yrs) for an a bdominal Burch. Preliminary results showed a significant difference in cost effectiveness between the procedures. The average cost for a lap aroscopic Burch was $2938.35 and for an abdominal Burch $5692.30. The higher costs for abdominal Burch were due to increased hospital stay. The cost-effectiveness ratios (cost/cure) were $3029.23 and $6324.78, respectively. Sensitivity analysis was performed to assess for robustn ess. Conclusions. The preliminary results show that a laparoscopic Bur ch is more cost-effective than the abdominal Burch in treating women w ith USI.