Cost-Effectiveness of Sacrohysteropexy Versus Hysterectomy With Sacrocolpopexy.

Abstract

<h4>Importance</h4>Limited evidence is available comparing the cost-effectiveness of mesh augmented repairs with and without uterine preservation. Our model suggests that minimally invasive supracervical hysterectomy with sacrocolpopexy (SCH-SCP) is cost-effective compared with minimally invasive sacrohysteropexy (MISH) as it decreases the number of subsequent major surgical procedures, endometrial cancer diagnoses, and endometrial cancer deaths. This information is useful for decision making at the health system level and should be considered in the surgical counseling discussion.<h4>Objective</h4>The objective of this study was to compare the cost-effectiveness of SCH-SCP versus MISH.<h4>Study design</h4>A decision tree model using TreeAge® software was developed to evaluate the cost-effectiveness of SCH-SCP compared with uterine-sparing MISH. Effectiveness was expressed in quality-adjusted life years (QALYs), and the willingness-to-pay (WTP) threshold was set to $100,000 per QALY. The literature review provided probabilities, utilities, and cost data. We estimated the incremental cost-effectiveness ratio (ICER) between the 2 strategies, completed a probabilistic sensitivity analysis (PSA), and created a cost-effectiveness acceptability curve for WTP thresholds from $0 to $200,000.<h4>Results</h4>SCH-SCP was a cost-effective strategy, with an ICER of $59,820/QALY compared with MISH. For a cohort of 10,000, MISH is associated with an additional 648 major surgical procedures, 5 endometrial cancer cases, and 2 endometrial cancer deaths. PSA revealed the chance of SCH-SCP being cost-effective was 55.4% at a WTP of $100,000 and 57.9% at a WTP of $200,000.<h4>Conclusion</h4>Our model suggests that SCH-SCP may be cost-effective compared with MISH. SCH-SCP decreases the number of additional major surgical procedures, endometrial cancer diagnoses, and endometrial cancer deaths in our analysis.