Journal article
Cost-Utility Analysis of Midurethral Sling Timing Among Women Undergoing Prolapse Surgery
Urogynecology, v 30(1), pp 65-72
01 Jan 2024
PMID: 37493280
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Importance There are no guidelines regarding the ideal timing of midurethral sling (MUS) placement following prolapse repair.Objective The objective of this study was to estimate the cost-utility of concomitant MUS versus staged MUS among women undergoing apical suspension surgery for pelvic organ prolapse.Study Design Cost-utility modeling using a decision analysis tree compared concomitant MUS with staged MUS over a 1-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER). Six scenarios were modeled to estimate cost-utilities for women with preoperative overt, occult, or no stress urinary incontinence (SUI) who underwent either minimally invasive sacrocolpopexy or vaginal native tissue apical suspension. Possible complications of de novo overactive bladder, urinary retention requiring sling lysis, mesh exposure, and persistent SUI were included. Costs from a third-party payer perspective were derived from Medicare 2022 reimbursements. One-way sensitivity analyses were performed.Results Among women without preoperative SUI, staged MUS was the dominant strategy for both surgical routes with higher utility and lower costs. For women with either occult or overt SUI undergoing sacrocolpopexy or vaginal repair, concomitant MUS was cost-effective (ICER = $21,114-$96,536 per quality-adjusted life-year). Therefore, concomitant MUS is preferred for patients with preoperative SUI as higher costs were offset by higher effectiveness. One-way sensitivity analyses demonstrated that ICERs were most affected by probability of cure following MUS.Conclusions A staged MUS procedure is the dominant strategy for women undergoing apical prolapse repair without preoperative SUI. In women with either overt or occult SUI, the ICER was below the willingness-to-pay threshold of $100,000 per quality-adjusted life-year, suggesting that concomitant MUS surgery is cost-effective.
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Details
- Title
- Cost-Utility Analysis of Midurethral Sling Timing Among Women Undergoing Prolapse Surgery
- Creators
- Jessica C. Sassani (Corresponding Author) - Drexel UniversityLauren E. Giugale - Magee-Womens HospitalErin Seifert Lavelle - Drexel UniversityJonathan P. Shepherd - UConn Health
- Publication Details
- Urogynecology, v 30(1), pp 65-72
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 8
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Obstetrics and Gynecology
- Web of Science ID
- WOS:001207658900001
- Scopus ID
- 2-s2.0-85181031141
- Other Identifier
- 991022135715304721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Obstetrics & Gynecology