Long-term costs of minimally-invasive sacral colpopexy compared to native tissue vaginal repair with concomitant hysterectomy

Study Objective To determine the long-term costs of hysterectomy with minimally-invasive sacrocolpopexy (MISCP) versus uterosacral ligament suspension (USLS) for primary uterovaginal prolapse repair. Study Design A hospital-based decision analysis model was built using TreeAge Pro (TreeAge Software Inc, Williamstown, MA). Those with prolapse were modeled to undergo either vaginal hysterectomy with uterosacral ligament suspension (USLS) or minimally invasive total hysterectomy with sacrocolpopexy (MISCP). We modeled the chance of complications of the index procedure, prolapse recurrence with the option for surgical retreatment, complications of the salvage procedure, and possible second prolapse recurrence. The primary outcome was cost of the surgical strategy. The proportion of patients living with prolapse after treatment was the secondary outcome. Setting Tertiary center for urogynecology Patients Female patients undergoing surgical repair by the same team for primary uterovaginal prolapse Interventions Comparison analysis of estimated long-term costs was performed Measurements and Main Results Our primary outcome showed that a strategy of undergoing MISCP as the primary index procedure cost $19,935 and that undergoing USLS as the primary index procedure cost $15,457, a difference of $4,478. Furthermore, 21.1% of women in the USLS group will be living with recurrent prolapse compared to 6.2% of MISCP patients. Switching from USLS to MISCP to minimize recurrence risk would cost $30,054 per case of prolapse prevented. Additionally, a surgeon would have to perform 6.7 cases by MISCP instead of USLS in order to prevent 1 patient from having recurrent prolapse. Conclusion The higher initial costs of MISCP compared to USLS persist in the long term after factoring in recurrence and complication rates, though more patients who undergo USLS live with prolapse recurrence.