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

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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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Funding

The authors report no financial support for the research.

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Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of South Florida, STC Building, 6th Floor, 2 Tampa General Circle, Tampa, FL, 33606, USA

    Allison M. Wyman, Renee Bassaly, Kristie A. Greene & Stuart Hart

  2. Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Suite 600, Houston, TX, 77098, USA

    Jason L. Salemi

  3. Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics and Gynecology, University of South Florida, STC Building, 6th Floor, 2 Tampa General Circle, Tampa, FL, 33606, USA

    Emad Mikhail

  4. Department of Industrial and Management Systems Engineering, University of South Florida, 4202 East Fowler Ave., ENB118, Tampa, FL, 33620, USA

    Susana Lai-Yuen

Authors
  1. Allison M. Wyman
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  2. Jason L. Salemi
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  3. Emad Mikhail
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  4. Renee Bassaly
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  5. Kristie A. Greene
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  6. Stuart Hart
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  7. Susana Lai-Yuen
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Correspondence to Allison M. Wyman.

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Paper Presentation Information

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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  • DOI: https://doi.org/10.1007/s00192-019-04089-3

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