Surgery versus collagen for female stress urinary incontinence: economic assessment in Ontario and Quebec.
Bibliographic record
Abstract
INTRODUCTION AND OBJECTIVE: The purpose of this study was to evaluate the cost-effectiveness of surgery versus collagen injection to treat female stress urinary incontinence after the failure of initial surgical treatment. The analysis was conducted from the health care system perspectives of Ontario and Quebec. MATERIALS AND METHODS: A decision-tree was constructed to compare each of three surgeries (i.e., retropubic suspension, transvaginal suspension, sling procedures) with collagen. An average cost estimate was generated for each intervention, as was an incremental cost-effectiveness ratio for each surgery-collagen comparison. RESULTS: In both Ontario and Quebec, the treatment with the lowest average cost was collagen (Ontario: collagen = 2695 dollars; Quebec: collagen = 2718 dollars). However, the surgeries had higher probabilities of success (defined as 'cure' - no urine leakage during follow-up examinations), with point estimates of at least.79 (.53 for collagen). Incremental cost-effectiveness ratios for the base case analyses of all treatment comparisons indicated that the cost to cure an additional patient with surgery could range from 1824 dollars to 6814 dollars in Ontario and 1388 dollars to 3008 dollars in Quebec. These ratios were sensitive to changes in the mean number of injections for collagen patients and to a reduction in the length of hospital stay for surgery to 1 day. CONCLUSIONS: Collagen injection may be cost-effective as a follow-up treatment to initial surgical failure in both Ontario and Quebec when the number of injections is kept to a minimum and hospital stays after surgery are relatively lengthy. Otherwise, surgery may be cost-effective.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.006 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".