title: Do patients prefer mesh or anterior colporrhaphy for primary correction of anterior vaginal wall prolapse: a labelled discrete choice experiment.
abstract: OBJECTIVE
  We investigated patients' preferences for anterior colporrhaphy or mesh surgery as surgical correction of anterior vaginal wall prolapse.
  
  
  METHODS
  Labelled discrete choice experiment.
  
  
  METHODS
  Three Dutch teaching hospitals.
  
  
  METHODS
  Women with anterior vaginal wall prolapse Pelvic Organ Prolapse Quantification stage 2 or more, indicated for anterior colporrhaphy (n = 100).
  
  
  METHODS
  Discrete choice experiments are an attribute-based survey method for measuring preferences. In this experiment, women were asked to choose between two treatment scenarios, mesh surgery or anterior colporrhaphy. These surgical treatments differed in four treatment attributes: (i) recurrence rate, (ii) exposure rate, (iii) infection rate, (iv) dyspareunia. Data were analysed using a multinomial logit model.
  
  
  METHODS
  Women's preferences for anterior colporrhaphy or mesh surgery for the repair of vaginal wall prolapse.
  
  
  RESULTS
  All treatment attributes, i.e. recurrence, exposure, infection and dyspareunia, proved to be significant in the woman's decision to choose mesh surgery (P < 0.001), while only two attributes out of three, recurrence and infection, were significant for anterior colporrhaphy (P < 0.001). The relative importance data showed that with regards to the four statistically significant attributes for mesh, dyspareunia was the most important attribute, and of the two significant attributes for anterior colporrhaphy, the risk of infection. Based on the attributes and levels in our discrete choice experiment, anterior colporrhaphy was preferred in 74% as a primary correction of anterior vaginal wall prolapse, followed by a preference for mesh in 26% of all choices.
  
  
  CONCLUSIONS
  This study showed that next to the risk of recurrence, other aspects like risk of infection, dyspareunia and exposure play a role in the woman's preference for a surgical treatment. In addition, our results indicate that anterior colporrhaphy is preferred in the majority of the choices, followed by a preference for mesh surgery in a quarter of all choice sets. However, these results represent the average preference of a sample of women and cannot be taken as the preference of each individual. In the medical decision-making context, information from the current study should be personalised to fit patient's unique circumstances. For patients to construct their own, individual preferences, they should be well informed about the existence and magnitude of the potential benefits and risks related to either anterior colporrhaphy or mesh surgery.
authors.affiliation: Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Kjb
authors.initials: K
authors.lastname: Notten
authors.affiliation: Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: B A
authors.initials: BA
authors.lastname: Essers
authors.affiliation: Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.|GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Weemhoff
authors.affiliation: Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Agh
authors.initials: A
authors.lastname: Rutten
authors.affiliation: Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: Jjae
authors.initials: J
authors.lastname: Donners
authors.affiliation: Obstetrics and Gynaecology, Viecuri Medical Centre, Venlo, the Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: van Gestel
authors.affiliation: Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands.|GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands.
authors.forename: Rfpm
authors.initials: R
authors.lastname: Kruitwagen
authors.affiliation: Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Jpwr
authors.initials: J
authors.lastname: Roovers
authors.affiliation: Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands.|CAPHRI-School of Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands.
authors.forename: C D
authors.initials: CD
authors.lastname: Dirksen
mesh_terms: D002755:Choice Behavior; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D019538:Health Care Surveys; D006801:Humans; D016015:Logistic Models; D057240:Patient Preference / Q000523:psychology* / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012008:Recurrence; D012306:Risk; D013526:Surgical Mesh; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
keywords: Anterior colporrhaphy; anterior vaginal wall prolapse; discrete choice experiment; mesh related complications; mesh surgery; patients’ preferences