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Surgical correction of the genital hiatus at the time of sacrocolpopexy — a 7-year Markov analysis: a cost-effectiveness analysis

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Abstract

Introduction and hypothesis

To perform a cost-effectiveness analysis of concurrent posterior repair performed at the time of laparoscopic hysterectomy with sacrocolpopexy over a 7-year time period. We hypothesize it is not cost-effective to perform a posterior colporrhaphy.

Methods

We used TreeAge Pro® to construct a decision model with Markov modeling to compare sacrocolpopexy with and without concurrent posterior repair (SCP and SCP+PR) over a time horizon of 7 years. Outcomes included probability and costs associated with prolapse recurrence, prolapse retreatment, and complications including rectal injury, rectovaginal hematoma requiring reoperation, and postoperative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) calculated as ∆ costs /∆ effectiveness and the willingness to pay (WTP) was set at $100,000/QALY.

Results

Our model showed that SCP was the dominant strategy, with lower costs (−$ 2681.06) and higher effectiveness (+0.10) compared to SCP+PR over the 7-year period. In two-way sensitivity analyses, we varied the probability of prolapse recurrence after both strategies. Our conclusions would only change if the probability of recurrence after SCP was at least 29.7% higher than after SCP+PR. When varying the probabilities of dyspareunia for both strategies, SCP+PR only became the dominant strategy if the probability of dyspareunia for SCP+PR was lower than the rate of SCP alone.

Conclusions

In this 7-year Markov cost-effectiveness analysis, SCP without concurrent PR was the dominant strategy. SCP+PR costs more with lower effectiveness than SCP alone, due to higher surgical cost of SCP+PR and higher probability of dyspareunia after SCP+PR.

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Contributions to authorship

OC, JS, BM, ES, SW — Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work.

OC, JS, BM, ES, SW — Drafting the work or revising it critically for important intellectual content.

OC, JS, BM, ES, SW — Final approval of the version to be published.

OC, JS, BM, ES, SW — Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Funding

This study was supported by an unrestricted grant provided by the Foundation for Female Health Awareness, who had no influence on the design of the study and writing of this manuscript.

Author information

Authors and Affiliations

  1. Division of Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction, Department of Urology, University of California Irvine, 3800 W. Chapman St, Suite 7200, Orange, CA, 92868, USA

    Olivia H. Chang

  2. Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, CT, USA

    Jonathan P. Shepherd

  3. Urogynecology and Reconstructive Pelvic Surgery, Yale School of Medicine, New Haven, CT, USA

    Brad St. Martin

  4. Urogynecology and Pelvic Reconstructive Surgery, Stanford University School of Medicine, Stanford, CA, USA

    Eric R. Sokol

  5. Center for Urogynecology and Pelvic Reconstructive Surgery, Women’s Health Institute, Cleveland Clinic, Cleveland, OH, USA

    Shannon Wallace

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  1. Olivia H. Chang
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Corresponding author

Correspondence to Olivia H. Chang.

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Not applicable since the study was based on modeling and previously published data.

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This study was presented as an oral presentation at the Society of Gynecologic Surgeons meeting in San Antonio, TX, USA in 2022.

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Chang, O.H., Shepherd, J.P., St. Martin, B. et al. Surgical correction of the genital hiatus at the time of sacrocolpopexy — a 7-year Markov analysis: a cost-effectiveness analysis. Int Urogynecol J 34, 2969–2975 (2023). https://doi.org/10.1007/s00192-023-05628-9

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