TITLE:
Cost-effectiveness analysis comparing robotic sacrocolpopexy to a vaginal mesh hysteropexy for treatment of uterovaginal prolapse
AUTHORS:
Patrick J. Culligan, Charbel Salamon, Christa Lewis, Troy D. Abell
KEYWORDS:
Cost-Effectiveness; Robotic-Sacrocolpopexy; Uterovaginal Prolapse; Vaginal-Mesh
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.3 No.8,
October
18,
2013
ABSTRACT: Objective:
To compare costs and QoL associated with 2 minimally invasive operations to
treat uterovaginal prolapse. Study Design: A decision analytic cost-effectiveness
model comparing vaginal mesh hysteropexy to robotic-assisted sacrocolpopexy.
Costs were derived from a hospital perspective. QoL estimates focused on:
recurrent prolapse; erosion; infection; transfusion; cystotomy; chronic pain;
lower urinary tract symptoms; and mortality. Actual procedural costs at our
institution were calculated. Costs and quality adjusted life years were
examined over 1 year. Results: The costs
($21,853) and QALYs (0.9645) for robotic sacrocolpopexy produced a CE Ratio of
$22,657 per QALY. The costs ($14,890) and QALYs (0.9309) for vaginal
mesh produced a CE Ratio of $15,995 per QALY. The incremental cost per QALYs
for robotic surgery was $207,232. Sensitivity
analysis on all utilities, cost estimates, and complication estimates didn’t cross any thresholds. Conclusion: Vaginal
mesh was more cost-effective than robotic sacrocolpopexy even when the cost of
the robot was not factored.