Abdominal sacral colpopexy versus sacrospinous ligament fixation: a cost-effectiveness analysis.
OBJECTIVE
For the surgical correction of apical prolapse the abdominal approach is associated with better outcomes; however, it is more expensive than the transvaginal approach. This cost-effectiveness analysis compares abdominal sacral colpopexy (ASC) with sacrospinous ligament fixation (SSLF) to determine if the improved outcomes of ASC justify the increased expense.


METHODS
A decision-analytic model was created comparing ASC with SSLF using data-modeling software, TreeAge Pro (2013), which included the following outcomes: post-operative stress urinary incontinence (SUI) with possible mid-urethral sling (MUS) placement, prolapse recurrence with possible re-operation, and post-operative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) of less than $50,000 per quality-associated life year (QALY). Base-case, threshold, and one-way sensitivity analyses were performed.


RESULTS
At the baseline, ASC is more expensive than SSLF ($13,988 vs $11,950), but is more effective (QALY 1.53 vs 1.45) and is cost-effective (ICER $24,574/QALY) at 2 years. ASC was not cost-effective if the following four thresholds were met: the rate of post-operative SUI was above 36 % after ASC or below 28 % after SSLF; the rate of MUS placement for post-operative SUI was above 60 % after ASC or below 13 % after SSLF; the rate of recurrent prolapse was above 15 % after ASC or below 4 % after SSLF; the rate of post-operative dyspareunia was above 59 % after ASC or below 19 % after SSLF.


CONCLUSIONS
Abdominal sacral colpopexy can be cost-effective compared with sacrospinous ligament fixation; however, as the post-operative outcomes of SSLF improve, SSLF can be considered a cost-effective alternative.
Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA. mikasohno@gmail.com.
Mika S
MS
Ohno
Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA.
Monica L
ML
Richardson
Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, Rm G332, Stanford, CA, 94305-5317, USA.
Eric R
ER
Sokol
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004414:Dyspareunia / Q000209:etiology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D006801:Humans; D008022:Ligaments / Q000601:surgery; D056887:Pelvic Organ Prolapse / Q000191:economics / Q000601:surgery*; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D053825:Suburethral Slings / Q000009:adverse effects / Q000191:economics; D014550:Urinary Incontinence, Stress / Q000209:etiology; D014621:Vagina / Q000601:surgery
Apical prolapse; Cost-effectiveness; Decision analysis; Modeling