Cost Effectiveness of Concurrent Midurethral Sling at the Time of Prolapse Repair: Results From a Randomized Controlled Trial.

Abstract

IMPORTANCE:

The relative cost per improvement in quality of life can help guide decisions about adding a midurethral sling at the time of prolapse surgery.

OBJECTIVE:

This study aimed to assess the cost-effectiveness of prophylactic midurethral slings placed at the time of prolapse surgery to reduce de novo urinary incontinence based on a randomized controlled trial.

STUDY DESIGN:

Costs and effectiveness were collected as part of a planned secondary analysis from the Outcomes following vaginal Prolapse repair and mid Urethral Sling (OPUS) trial, where 337 women without symptomatic stress urinary incontinence were randomly assigned to a midurethral sling or sham incisions during vaginal prolapse surgery. Within-trial cost-effectiveness analysis was performed from the societal perspective. Effectiveness was measured in quality-adjusted life-years (QALYs) and de novo urinary incontinence. We calculated incremental cost-effectiveness ratios and cost-effectiveness acceptability curves.

RESULTS:

Within-trial societal costs were higher for the sling group than for the control group ($18,170 [95% confidence interval (CI), $16,420-$19,920] vs $15,700 [95% CI, $14,110-$17300], P = 0.041). The changes in QALY were 0.04 (95% CI, 0.02-0.06) versus 0.03 (95% CI, 0.02-0.05; P = 0.54). The incremental cost-effectiveness ratio for prophylactic sling was $309,620/QALY. This is above the generally accepted range of willingness-to-pay thresholds of $50,000 to $150,000/QALY. At 1 year, urinary incontinence was more common in the control group, and the cost to prevent 1 case was $91. The probability that prophylactic sling is cost-effective is 24%.

CONCLUSIONS:

Prophylactic sling placed during vaginal prolapse surgery reduced the rate of de novo urinary incontinence, but was not cost-effective.

• Authors: Rui Wang, Paul Tulikangas, Elisabeth C Sappenfield
• Journal: Urogynecology (Philadelphia, Pa.) (Urogynecology (Phila)) Vol. 29 Issue 5 Pg. 461-468 (05 01 2023) ISSN: 2771-1897 [Electronic] United States
• PMID: 36701323 (Publication Type: Randomized Controlled Trial, Journal Article)
• Copyright: Copyright © 2022 American Urogynecologic Society. All rights reserved.

Topics

• Female
• Humans
• Suburethral Slings
• Uterine Prolapse (surgery)
• Cost-Effectiveness Analysis
• Quality of Life
• Urinary Incontinence (surgery)