Abdominal sacral colpopexy versus sacrospinous ligament fixation: a cost-effectiveness analysis
Introduction and hypothesis
For the surgical correction of apical prolapse the abdominal approach is associated with better outcomes; however, it is more expensive than the transvaginal approach. This cost-effectiveness analysis compares abdominal sacral colpopexy (ASC) with sacrospinous ligament fixation (SSLF) to determine if the improved outcomes of ASC justify the increased expense.
A decision-analytic model was created comparing ASC with SSLF using data-modeling software, TreeAge Pro (2013), which included the following outcomes: post-operative stress urinary incontinence (SUI) with possible mid-urethral sling (MUS) placement, prolapse recurrence with possible re-operation, and post-operative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) of less than $50,000 per quality-associated life year (QALY). Base-case, threshold, and one-way sensitivity analyses were performed.
At the baseline, ASC is more expensive than SSLF ($13,988 vs $11,950), but is more effective (QALY 1.53 vs 1.45) and is cost-effective (ICER $24,574/QALY) at 2 years. ASC was not cost-effective if the following four thresholds were met: the rate of post-operative SUI was above 36 % after ASC or below 28 % after SSLF; the rate of MUS placement for post-operative SUI was above 60 % after ASC or below 13 % after SSLF; the rate of recurrent prolapse was above 15 % after ASC or below 4 % after SSLF; the rate of post-operative dyspareunia was above 59 % after ASC or below 19 % after SSLF.
Abdominal sacral colpopexy can be cost-effective compared with sacrospinous ligament fixation; however, as the post-operative outcomes of SSLF improve, SSLF can be considered a cost-effective alternative.
KeywordsApical prolapse Cost-effectiveness Decision analysis Modeling
Abdominal sacral colpopexy
Incremental cost-effectiveness ratio
Quality-associated life year
Sacrospinous ligament fixation
Stress urinary incontinence
Conflict of interest
Dr Eric Sokol has received research grants from El.En. S.p.A, Cook MyoSite, Coloplast, and ACell. He is a National Principal Investigator with American Medical Systems and receives consulting fees. He is on the Society of Gynecologic Surgeons Executive Board and on the American Urogynecologic Society Scientific Program Committee. He reports no conflicts of interest with this body of research. Dr Mika Ohno and Dr Monica Richardson report no conflicts of interest.
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