Cost-effectiveness of prophylactic retropubic sling at the time of vaginal prolapse surgery

Cost Effectiveness of Concurrent Midurethral Sling at the Time of Prolapse Repair: Results From a Randomized Controlled Trial

“…22 A recent modeling cost-effectiveness analysis found that selective sling placement, where patients with a positive prolapse-reduced cough stress test result were treated with prophylactic sling, to be the cost-effective strategy in treating de novo SUI 1 year after vaginal prolapse repair. 23 Although model-based cost-effectiveness analyses are able to study several clinical scenarios and use multiple data sources, the results are only as good as the models and the data inputs. Most modeling cost-effectiveness analyses, including Mou et al, 23 assign a single health utility in QALYs to a few health states, such as having urinary incontinence or not having urinary incontinence, instead of modeling the dynamic nature of the disease and treatment process.…”

“…23 Although model-based cost-effectiveness analyses are able to study several clinical scenarios and use multiple data sources, the results are only as good as the models and the data inputs. Most modeling cost-effectiveness analyses, including Mou et al, 23 assign a single health utility in QALYs to a few health states, such as having urinary incontinence or not having urinary incontinence, instead of modeling the dynamic nature of the disease and treatment process. Similarly, costs are assumed to follow the pathways outlined in models and often do not capture societal costs such as personal care products, work missed, and productivity losses.…”

“…Another model-based cost-effectiveness analysis for the treatment of SUI found that surgical correction is likely the most cost-effective treatment in young healthy women because of the high success rates of the midurethral sling 22 . A recent modeling cost-effectiveness analysis found that selective sling placement, where patients with a positive prolapse-reduced cough stress test result were treated with prophylactic sling, to be the cost-effective strategy in treating de novo SUI 1 year after vaginal prolapse repair 23 . Although model-based cost-effectiveness analyses are able to study several clinical scenarios and use multiple data sources, the results are only as good as the models and the data inputs.…”

“…The advantage of our within-trial cost-effectiveness analysis over modeling is that both the health utilities (in terms of QALYs) and costs (in terms of direct medical utilization and indirect productivity loss and personal care resources) are derived directly from patient reports instead of using researchers' own constructs of what and how much each health state and treatment would affect the patient's health and resource utilization. For example, Mou et al 23 uses a single source for their QALY estimates for overactive bladder and SUI, which is a Canadian community survey 24 of individuals with chronic conditions, including urinary incontinence. Whereas our QALY data came from prospectively collected questionnaires at multiple time points during the period before and up to a year after surgery.…”

Making Decisions in a Consensus-Free Zone: Is Sling for Possible Occult SUI the Urogynecologist’s Rorschach Test?

“…Many of us would like to call ourselves patient-focused . Indeed, Mou et al 6 performed a recently published CEA to answer the same question, also using sling efficacy data from the Pelvic Floor Disorders Network’s OPUS trial, but allowing for a strategy of selective sling in those with a positive preoperative standing cough stress test result. They found selective sling to be cost effective when compared with a staged approach, whereas the strategy of universal sling was dominated (both less effective and higher cost than selective sling).…”