Research Urogynecology| Volume 206, ISSUE 5, P433.e1-433.e7, May 01, 2012

Cost minimization analysis of laparoscopic sacral colpopexy and total vaginal mesh

Published:December 19, 2011

Objective

The objective of the study was a cost minimization analysis of the laparoscopic sacral colpopexy (LSC) and total vaginal mesh (TVM).

Study Design

Primary clinical costs were derived from our randomized control trial comparing LSC and TVM and were compared using prices from privately- and publicly-conducted procedures. Womens' opportunity cost of time were added to these estimates to produce estimates of the primary economic costs of the procedures. Reoperation costs were added to estimate the economic cost per subject.

LSC has lower mean primary clinical cost as compared with the TVM in both the public (mean difference, $1102.96; 95% confidence interval [CI], 468.52–1737.385) and private models (mean difference,$1176.68; 95% CI, 1116.85–1236.51), respectively. Mean total economic costs were significantly lower in the LSC group as compared with the TVM ($4013.07; 95% CI, 3107.77–4918.37). Labor costs were significantly greater in the LSC but were offset by lower consumable, inpatient, opportunity, and reoperation costs as compared with the TVM. Conclusion The LSC has lower economic cost than TVM. Key words References • Lawrence J.M. • Lukacz E.S. • Nager C.W. • Hsu J.W. • Luber K.M. Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women. Obstet Gynecol. 2008; 111: 678-685 • Bradley C.S. • Kenton K.S. • Richter H.E. • et al. Obesity and outcomes after sacrocolpopexy. Am J Obstet Gynecol. 2008; 199: 690.e1-690.e8 • Olsen A.L. • Smith V.J. • Bergstrom J.O. • Colling J.C. • Clark A.L. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997; 89: 501-506 • Smith F.J. • Holman C.D. • Moorin R.E. • Tsokos N. Lifetime risk of undergoing surgery for pelvic organ prolapse. Obstet Gynecol. 2010; 116: 1096-1100 • Wu J.M. • Hundley A.F. • Fulton R.G. • Myers E.R. Forecasting the prevalence of pelvic floor disorders in U.S. women: 2010 to 2050. Obstet Gynecol. 2009; 114: 1278-1283 • Ward K.L. • Hilton P. A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up. Am J Obstet Gynecol. 2004; 190: 324-331 • Manca A. • Sculpher M.J. • Ward K. • Hilton P. A cost-utility analysis of tension-free vaginal tape versus colposuspension for primary urodynamic stress incontinence. BJOG. 2003; 110: 255-262 • Altman D. • Vayrynen T. • Engh M.E. • Axelsen S. • Falconer C. Anterior colporrhaphy versus transvaginal mesh for pelvic-organ prolapse. N Engl J Med. 2011; 364: 1826-1836 • Iglesia C.B. • Sokol A.I. • Sokol E.R. • et al. Vaginal mesh for prolapse: a randomized controlled trial. Obstet Gynecol. 2010; 116: 293-303 • Maher C.F. • Feiner B. • DeCuyper E.M. • Nichlos C.J. • Hickey K.V. • O'Rourke P. Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol. 2011; 204: 360.e1-360.e7 • Nguyen J.N. • Burchette R.J. Outcome after anterior vaginal prolapse repair: a randomized controlled trial. Obstet Gynecol. 2008; 111: 891-898 • Withagen M.I. • Milani A.L. • den Boon J. • Vervest H.A. • Vierhout M.E. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: a randomized controlled trial. Obstet Gynecol. 2011; 117: 242-250 • Australian Bureau of Statistics Average weekly earnings, Canberra. Australian Bureau of Statistics, 2010 • Baessler K. • O'Neill S.M. • Maher C.F. • Battistutta D. A validated self-administered female pelvic floor questionnaire. Int Urogynecol J. 2010; 21: 163-172 • Digesu G.A. • Khullar V. • Cardozo L. • Robinson D. • Salvatore S. P-QOL: a validated questionnaire to assess the symptoms and quality of life of women with urogenital prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2005; 16 (discussion 81): 176-181 • Murray S. • Haverkorn R.M. • Lotan Y. • Lemack G.E. Mesh kits for anterior vaginal prolapse are not cost effective. Int Urogynecol J. 2011; 22: 447-452 • Patel B.N. • Smith J.J. • Badlani G.H. Minimizing the cost of surgical correction of stress urinary incontinence and prolapse. Urology. 2009; 74: 762-764 • Maher C.F. • Qatawneh A.M. • Dwyer P.L. • Carey M.P. • Cornish A. • Schluter P.J. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004; 190: 20-26 • Sokol A.I. • Iglesia C.B. • Kudish B.I. • et al. One-year objective and functional outcomes of a randomized clinical trial of vaginal mesh for prolapse. American Journal of Obstetrics and Gynecology. 2012; 206: 86.e1-86.e9 • Nieminen K. • Hiltunen R. • Takala T. • et al. Outcomes after anterior vaginal wall repair with mesh: a randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol. 2010; 203: 235.e1-235.e8 • Bijen C.B. • Vermeulen K.M. • Mourits M.J. • et al. Cost effectiveness of laparoscopy versus laparotomy in early stage endometrial cancer: a randomised trial. Gynecol Oncol. 2011; 121: 76-82 • Shippert R.S. A study of time-dependent operating room fees and how to save$100,000 by using time savings products.
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