Analytic model comparing the cost utility of TVT versus duloxetine in women with urinary stress incontinence

Int Urogynecol J. 2010 Aug;21(8):977-84. doi: 10.1007/s00192-010-1132-2. Epub 2010 Mar 27.


Introduction and hypothesis: The purpose of this study was to assess cost utility of duloxetine versus tension-free vaginal tape (TVT) as a second-line treatment for urinary stress incontinence.

Methods: A Markov model was used to compare the cost utility based on a 2-year follow-up period. Quality-adjusted life year (QALY) estimation was performed by assuming a disutility rate of 0.05.

Results: Under base-case assumptions, although duloxetine was a cheaper option, TVT gave a considerably higher QALY gain. When a longer follow-up period was considered, TVT had an incremental cost-effectiveness ratio (ICER) of pound 7,710 ($12,651) at 10 years. If the QALY gain from cure was 0.09, then the ICER for duloxetine and TVT would both fall within the indicative National Institute for Health and Clinical Excellence willingness to pay threshold at 2 years, but TVT would be the cost-effective option having extended dominance over duloxetine.

Conclusions: This model suggests that TVT is a cost-effective treatment for stress incontinence.

Publication types

  • Comparative Study

MeSH terms

  • Cost-Benefit Analysis
  • Duloxetine Hydrochloride
  • Female
  • Humans
  • Markov Chains
  • Models, Statistical*
  • Quality-Adjusted Life Years
  • Sensitivity and Specificity
  • Serotonin Uptake Inhibitors / economics
  • Serotonin Uptake Inhibitors / therapeutic use
  • Suburethral Slings / economics*
  • Thiophenes / economics*
  • Thiophenes / therapeutic use*
  • Treatment Outcome
  • Urinary Incontinence, Stress / economics*
  • Urinary Incontinence, Stress / therapy*


  • Serotonin Uptake Inhibitors
  • Thiophenes
  • Duloxetine Hydrochloride