Cost-effectiveness of a preoperative pelvic MRI in pelvic organ prolapse surgery

Abstract

Objective

To investigate the cost-effectiveness of preoperative pelvic magnetic resonance imaging (MRI) in identifying women at high risk of surgical failure following apical repair for pelvic organ prolapse (POP).

Methods

A decision tree (TreeAgePro Healthcare software) was designed to compare outcomes and costs of screening with a pelvic MRI versus no screening. For the strategy with MRI, expected surgical outcomes were based on a calculated value of the estimated levator ani subtended volume (eLASV) from previously published work. For the alternative strategy of no MRI, estimates for surgical outcomes were obtained from the published literature. Costs for surgical procedures were estimated using the 2008–2014 National Inpatient Sample (NIS). A cost-effectiveness analysis from a third-party payer perspective was performed with the primary measure of effectiveness defined as avoidance of surgical failure. Deterministic and probabilistic sensitivity analyses were performed to assess how robust the calculated incremental cost-effectiveness ratio was to uncertainty in decision tree estimates and across a range of willingness-to-pay values.

Results

A preoperative MRI resulted in a 17% increased chance of successful initial surgery (87% vs. 70%) and a decreased risk of repeat surgery with an ICER of $2298 per avoided cost of surgical failure. When applied to annual expected women undergoing POP surgery, routine screening with preoperative pelvic MRI costs $90 million more, but could avoid 39,150 surgical failures.

Conclusion

The use of routine preoperative pelvic MRI appears to be cost-effective when employed to identify women at high risk of surgical failure following apical repair for pelvic organ prolapse.

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References

  1. 1.

    Nygaard I, Barber MD, Burgio KL, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA. 2008;300:1311–6.

    CAS  Article  Google Scholar 

  2. 2.

    Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.

    CAS  Article  Google Scholar 

  3. 3.

    Asante A, Whiteman MK, Kulkarni A, et al. Elective oophorectomy in the United States: trends and in-hospital complications, 1998-2006. Obstet Gynecol. 2010;116:1088.

    Article  Google Scholar 

  4. 4.

    Boyles SH, Weber AM, Meyn L. Procedures for pelvic organ prolapse in the United States, 1979-1997. Am J Obstet Gynecol. 2003;188:108–15.

    Article  Google Scholar 

  5. 5.

    Erekson EA, Lopes VV, Raker CA, Sung VW. Ambulatory procedures for female pelvic floor disorders in the United States. Am J Obstet Gynecol. 2010;203:497.e1–5.

    Article  Google Scholar 

  6. 6.

    Subak LL, Waetjen LE, van den Eeden S, Thom DH, Vittinghoff E, Brown JS. Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol. 2001;98:646–51.

    CAS  PubMed  Google Scholar 

  7. 7.

    Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol. 2011;205:230.e1–5.

    Article  Google Scholar 

  8. 8.

    Wyman AM, Rodrigues AA, Hahn L, et al. Estimated Levator Ani subtended volume (eLASV): a novel Asssay for predicting surgical failure after uterosacral ligament suspension. Am J Obstet Gynecol 2016.

  9. 9.

    Rodriques AA Jr, Bassaly R, McCullough M, et al. Levator ani subtended volume: a novel parameter to evaluate levator ani muscle laxity in pelvic organ prolapse. Am J Obstet Gynecol. 2012;206:244.e1–9.

    Article  Google Scholar 

  10. 10.

    Rodriques AA Jr, Herrera-Hernadez MC, Bassaly R, et al. Estimates of the levator ani subtended volume based on magnetic resonance linear measurements. Neurourol Urodyn. 2016;35(2):199–205.

    Article  Google Scholar 

  11. 11.

    DeLancy JOL. Anatomy and biomechanics of genital prolapse. Clin Obstet Gynecol. 1993;36(4):897–909.

    Article  Google Scholar 

  12. 12.

    Norton P. Pelvic floor disorders: the role of fascia and ligaments. Clin Obstet Gynecol. 1993;36(4):926–38.

    CAS  Article  Google Scholar 

  13. 13.

    Barber MD, Brubaker L, Burgio KL, et al. Eunice Kennedy Shriver National Institute of Child Health and Human Development Pelvic Floor Disorders Network. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311(10):1023–34. https://doi.org/10.1001/jama.2014.1719.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Nygard I, Brubaker L, Zyczynsju H, et al. Long term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA. 2013;309(19):2016–24.

    Article  Google Scholar 

  15. 15.

    Barber MD, Brubaker L, Nygaard I, et al. Defining success after surgery for pelvic organ prolapse. Obstet Gynecol. 2009;114:600–9.

    Article  Google Scholar 

  16. 16.

    US Department of Labor, Bureau of Labor Statistics. Consumer price index: All urban consumers-(CPI-U). http://www.bls.gov/data. Accessed June 18, 2016.

  17. 17.

    Barber MD, Maher C. Apical Prolapse. Int Urogynecol J. 2013;24(110):1815–33.

    Article  Google Scholar 

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Correspondence to Allison M. Wyman.

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Oral poster presentation at the AUGS 38th Annual Scientific Meeting/PFD Week, October 2017, Providence, RI

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Wyman, A.M., Salemi, J.L., Mikhail, E. et al. Cost-effectiveness of a preoperative pelvic MRI in pelvic organ prolapse surgery. Int Urogynecol J 31, 1443–1449 (2020). https://doi.org/10.1007/s00192-019-04089-3

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Keywords

  • Cost-effectiveness analysis
  • Pelvic organ prolapse
  • Pelvic magnetic resonance imaging
  • MRIs