As highlighted in the accompanying clinical article,1 female urinary incontinence is a common clinical problem for which Burch colposuspension is a standard surgical approach. Colposuspension can be carried out as an open procedure or as a minimally invasive laparoscopic procedure. However, there is little robust evidence regarding the comparable cost effectiveness of the two alternative methods. As well as investigating the clinical effectiveness of alternative treatment strategies, in a limited budget environment like that in which many publicly funded healthcare systems operate, it is vital to assess whether any additional costs incurred by adopting the more expensive treatment strategy are counterbalanced by additional health benefits for the patients. Cost-effectiveness analysis (CEA) provides a formal analytical framework within which to assess whether a particular health technology provides ‘good value for money’. In principle, laparoscopic colposuspension may be expected to confer potential economic advantages when compared with the open procedure since women receiving laparoscopic surgery may have reduced length of hospital stay, better health-related quality of life in the postsurgery period and a quicker recovery.2 However, previous economic analyses of these two colposuspension techniques are methodologically weak and have not been conducted as part of published randomised controlled trials.3–5 Furthermore, since most economic analyses were carried out for other healthcare systems, the relevance of their results to the UK NHS decision-making process is unclear.
The Colposuspension Laparoscopic or Open (COLPO) trial funded by the UK Medical Research Council (MRC) is the largest randomised controlled trial to simultaneously assess the clinical and cost effectiveness of open versus laparoscopic colposuspension in patients in UK. This article reports the CEA of this trial.