Cost minimization analysis of laparoscopic sacral colpopexy and total vaginal mesh

Published:December 19, 2011DOI:


      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.


      The LSC has lower economic cost than TVM.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • 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.
        Am J Cosmetic Surg. 2005; 22: 25-34

      Linked Article

      • Cost minimization minilaparotomy vs laparoscopic sacral colpopexy
        American Journal of Obstetrics & GynecologyVol. 207Issue 2
        • Preview
          I read with interest the paper entitled “Cost minimization analysis of laparoscopic sacral colpopexy and total vaginal mesh” by Drs Christopher F. Maher and Luke B. Connelly.1 The paper focused on cost containment for the treatment of uterine prolapse. I noticed that the authors considered laparoscopy vs the total mesh vaginal approach. This very well-done study did not mention the inexpensive minilaparotomy approach.
        • Full-Text
        • PDF