title: Treatment strategies for pelvic organ prolapse: a cost-effectiveness analysis.
abstract: OBJECTIVE
  To compare the relative cost effectiveness of treatment decision alternatives for post-hysterectomy pelvic organ prolapse (POP).
  
  
  METHODS
  A Markov decision analysis model was used to assess and compare the relative cost effectiveness of expectant management, use of a pessary, and surgery for obtaining months of quality-adjusted life over 1 year. Sensitivity analysis was conducted to determine whether the results depended on specific estimates of patient utilities for pessary use, probabilities for complications and other events, and estimated costs.
  
  
  RESULTS
  Only two treatment alternatives were found to be efficient choices: initial pessary use and vaginal reconstructive surgery (VRS). Pessary use (including patients that eventually transitioned to surgery) achieved 10.4 quality-adjusted months, at a cost of $10,000 per patient, while VRS obtained 11.4 quality-adjusted months, at $15,000 per patient. Sensitivity analysis demonstrated that these baseline results depended on several key estimates in the model.
  
  
  CONCLUSIONS
  This analysis indicates that pessary use and VRS are the most cost-effective treatment alternatives for treating post-hysterectomy vaginal prolapse. Additional research is needed to standardize POP outcomes and complications, so that healthcare providers can best utilize cost information in balancing the risks and benefits of their treatment decisions.
authors.affiliation: Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA, USA. khullfish@virginia.edu
authors.forename: Kathie L
authors.initials: KL
authors.lastname: Hullfish
authors.forename: Elisa R
authors.initials: ER
authors.lastname: Trowbridge
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
mesh_terms: D003362:Cost-Benefit Analysis; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000191:economics*; D008390:Markov Chains; D056887:Pelvic Organ Prolapse / Q000191:economics / Q000628:therapy*; D010570:Pessaries / Q000191:economics*; D018570:Risk Assessment; D012371:Robotics / Q000191:economics*