title: Comparative analysis of overall cost and rate of healthcare utilization among apical prolapse procedures.
abstract: OBJECTIVE
  The annual cost of prolapse surgeries is expected to grow at twice the rate of population growth. Understanding the economic impact of apical prolapse procedures, including sacrospinous fixation (SSF), abdominal sacrocolpopexy (ASC), and laparoscopic sacrocolpopexy (LSC), is crucial. We aimed to compare overall cost of SSF versus ASC and LSC, as well as health resource utilization, up to 90-day follow-up.
  
  
  METHODS
  Truven Marketscan Commercial Claims and Encounter databases 2008-2012 were used to calculate index and 90-day follow-up costs for SSF, ASC, and LSC with/without hysterectomy. Rates of inpatient readmissions, outpatient visits, and emergency room (ER) visits were also calculated during the follow-up period. Statistical analyses were performed using SAS 9.3.
  
  
  RESULTS
  There were 17,549 SSF, 6126 ASC, and 10,708 LSC procedures. Mean index cost was lower for SSF (US$10,993) than ASC ($12,763, p < 0.0001) and LSC ($13,647, p < 0.0001). Concurrent hysterectomy impacted costs. Follow-up costs were likewise lower for SSF ($13,916) than ASC ($15,716, p < 0.0001) and LSC ($16,838, p < 0.0001). Lower rates of readmission were reported in SSF (4.22%) than ASC (5.40%, p = 0.0001) and LSC (4.64%, p = 0.0411). The rate of at least one ER visit was also lower for SSF (10.9%) than for ASC (12.0%, p = 0.0170) and comparable with LSC (10.6%, p = 0.0302).
  
  
  CONCLUSIONS
  Overall mean costs are significantly lower for SSF than ASC/LSC, as are those for health resource utilization. Besides lower morbidity rates being associated with vaginal procedures, our results demonstrate another reason to consider the increased use of SSF over sacrocolpopexies in apical prolapse surgery.
authors.affiliation: Department of Obstetrics and Gynecology, University of Nevada School of Medicine, 1707 West Charleston Blvd, Suite 120, Las Vegas, NV, 89102, USA.
authors.forename: Lannah L
authors.initials: LL
authors.lastname: Lua
authors.affiliation: Department of Obstetrics and Gynecology, University of Nevada School of Medicine, 1707 West Charleston Blvd, Suite 120, Las Vegas, NV, 89102, USA.
authors.forename: Erika D
authors.initials: ED
authors.lastname: Vicente
authors.affiliation: Department of Obstetrics and Gynecology, University of Nevada School of Medicine, 1707 West Charleston Blvd, Suite 120, Las Vegas, NV, 89102, USA.
authors.forename: Prathamesh
authors.initials: P
authors.lastname: Pathak
authors.affiliation: Department of Obstetrics and Gynecology, University of Nevada School of Medicine, 1707 West Charleston Blvd, Suite 120, Las Vegas, NV, 89102, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Lybbert
authors.affiliation: Department of Obstetrics and Gynecology, University of Nevada School of Medicine, 1707 West Charleston Blvd, Suite 120, Las Vegas, NV, 89102, USA. vdandolu@medicine.nevada.edu.
authors.forename: Vani
authors.identifier: http://orcid.org/0000-0001-7391-8080
authors.initials: V
authors.lastname: Dandolu
mesh_terms: D000328:Adult; D000368:Aged; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000191:economics*; D006801:Humans; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012189:Retrospective Studies
keywords: Abdominal sacrocolpopexy; Apical prolapse; Healthcare costs; Healthcare utilization; Laparoscopic sacrocolpopexy; Sacrospinous ligament fixation