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International Urogynecology Journal

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31-08-2023 | Sacrocolpopexy | Original Article

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

Authors: Olivia H. Chang, Jonathan P. Shepherd, Brad St. Martin, Eric R. Sokol, Shannon Wallace

Published in: International Urogynecology Journal | Issue 12/2023

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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Title: Surgical correction of the genital hiatus at the time of sacrocolpopexy — a 7-year Markov analysis: a cost-effectiveness analysis
Authors: Olivia H. Chang
Jonathan P. Shepherd
Brad St. Martin
Eric R. Sokol
Shannon Wallace
Publication date: 31-08-2023
Publisher: Springer International Publishing
Keywords: Sacrocolpopexy
Dyspareunia
Hematoma
Hysterectomy
Published in: International Urogynecology Journal / Issue 12/2023
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-023-05628-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

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