Division of Female Urology, Pelvic Reconstructive Surgery & Voiding Dysfunction, Department of Urology, University of California Irvine, 3800 W. Chapman St, Suite 7200, Orange, CA, 92868, USA.
Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington, CT, USA.
Int Urogynecol J. 2023 Dec;34(12):2969-2975. doi: 10.1007/s00192-023-05628-9. Epub 2023 Aug 31.
To perform a cost-effectiveness analysis of concurrent posterior repair performed at the time of laparoscopic hysterectomy with sacrocolpopexy over a 7-year time period. We hypothesize it is not cost-effective to perform a posterior colporrhaphy.
We used TreeAge Pro® to construct a decision model with Markov modeling to compare sacrocolpopexy with and without concurrent posterior repair (SCP and SCP+PR) over a time horizon of 7 years. Outcomes included probability and costs associated with prolapse recurrence, prolapse retreatment, and complications including rectal injury, rectovaginal hematoma requiring reoperation, and postoperative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) calculated as ∆ costs /∆ effectiveness and the willingness to pay (WTP) was set at $100,000/QALY.
Our model showed that SCP was the dominant strategy, with lower costs (-$ 2681.06) and higher effectiveness (+0.10) compared to SCP+PR over the 7-year period. In two-way sensitivity analyses, we varied the probability of prolapse recurrence after both strategies. Our conclusions would only change if the probability of recurrence after SCP was at least 29.7% higher than after SCP+PR. When varying the probabilities of dyspareunia for both strategies, SCP+PR only became the dominant strategy if the probability of dyspareunia for SCP+PR was lower than the rate of SCP alone.
In this 7-year Markov cost-effectiveness analysis, SCP without concurrent PR was the dominant strategy. SCP+PR costs more with lower effectiveness than SCP alone, due to higher surgical cost of SCP+PR and higher probability of dyspareunia after SCP+PR.
对腹腔镜子宫切除术同时进行后修补术与骶骨阴道固定术在 7 年内的成本效益进行分析。我们假设进行后阴道修补术并不具有成本效益。
我们使用 TreeAge Pro®构建了一个决策模型，采用马尔可夫模型对 7 年内骶骨阴道固定术与同时进行后修补术（SCP 和 SCP+PR）进行比较。结果包括脱垂复发、脱垂再治疗以及包括直肠损伤、需要再次手术的直肠阴道血肿和术后性交困难等并发症的发生概率和成本。成本效益定义为增量成本效益比（ICER），即 ∆成本/∆效果，意愿支付（WTP）设定为 10 万美元/QALY。
我们的模型表明，SCP 是一种主导策略，与 SCP+PR 相比，其成本更低（-2681.06 美元），效果更高（增加 0.10）。在双向敏感性分析中，我们改变了两种策略后脱垂复发的概率。只有当 SCP 后复发的概率比 SCP+PR 后至少高 29.7%时，我们的结论才会改变。当改变两种策略下性交困难的概率时，只有当 SCP+PR 后性交困难的概率低于单独 SCP 时，SCP+PR 才成为主导策略。
在这项 7 年的马尔可夫成本效益分析中，不伴有同期 PR 的 SCP 是一种主导策略。SCP+PR 的成本更高，效果更低，因为 SCP+PR 的手术成本更高，SCP+PR 后性交困难的概率更高。
