The Effectiveness and cost-effectiveness of Surgical Treatments for womEn with stRess urinary incontinence: an evidence synthesis (ESTER)

Brazzelli M, Javanbakht M, Imamura M, Hudson J, Moloney E, Becker F, Wallace S, Omar M I, Shimonovich M, MacLennan G, Ternent L, Vale L, Montgomery I, Mackie P, Saraswat L, Monga A, Craig D
Record ID 32016001090
Authors' objectives: Urinary incontinence in women is a common condition that can have a huge impact on the sufferers quality of life. There are many different types of incontinence, which vary in severity and in which treatment options work best. The focus of this research is on surgery for women with a) stress urinary incontinence (leaking urine when coughing or exercising) or b) stress-predominant mixed urinary incontinence (with urgency as well as stress). There are currently nine different types of surgery for this kind of incontinence, some of which are used more commonly than others. There have been recent concerns about the safety of the most popular type of surgery, mid-urethral slings which use mesh or tape as a sling to stop leakage. Research to date has focused on comparing one type with another, rather than comparing results across all of the techniques. It has not therefore been possible for decision-makers, doctors and patients to identify which of the nine surgical techniques is best and safest. We plan to fully investigate the clinical effectiveness, safety and costs of all nine available surgical techniques. Firstly, we will do this by undertaking a systematic review of all of the relevant research on effectiveness and safety. Systematic reviews find, assess and amalgamate (i.e. synthesise) evidence from clinical studies in order to answer an important question. They are strictly designed in advance in order to make them as reliable, transparent and free from bias as possible. Secondly we will use statistical methods to pull together all the evidence we have gathered in order to form a network, rather like a spider s web. Each strand of the web will then be combined with the others, so that we can compare all of the surgical techniques with each other, something that has not been available in research to date. Finally, the results on effectiveness and safety will be combined with information on the costs so that we can see if the different surgical techniques are good value to the NHS. The results obtained will enable decision-makers to identify which type of surgery is most clinically effective and safe for the patient and best value to the NHS. As always there will be some imprecision in the results. We will therefore use established methods to a) demonstrate whether the imprecision makes a difference to the results and b) whether more research in that area is worthwhile. The research team consists of clinicians with expertise in the treatment of women with urinary incontinence and researchers with expertise in systematic reviews, statistics and economic analysis. The project advisory group will also include two patient/public members and we have been in touch with the Bladder and Bowel Foundation and the Cochrane Consumer Group for assistance with recruitment in this area. In addition, we have already recruited one lay member who has been actively involved in putting together this proposal. The research will be mainly conducted at Aberdeen and Newcastle Universities. The two groups have a track record in successfully delivering this type of joint work. The project will take 14 months. Most of the funding requested is to pay for researchers time over this 14 month period. The remaining costs are for co-applicant time to provide advice, costs for patient/lay members time, administration and meeting time, and cost for obtaining papers for the systematic review.
Project Status: Completed
Year Published: 2019
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: England, United Kingdom
MeSH Terms
  • Urologic Surgical Procedures
  • Cost-Benefit Analysis
  • Female
  • Urinary Incontinence, Stress
  • Urodynamics
Organisation Name: NIHR Health Technology Assessment programme
Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
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