Cost-Effectiveness of Vaginal Mesh Hysteropexy Versus Hysterectomy/USLS: SUPeR Trial.

IMPORTANCE: Pelvic organ prolapse is a common and burdensome condition. Hysterectomies are commonly performed with prolapse surgical repair; however, hysteropexy, a uterine-preserving surgical procedure, lessens operative time and is often preferred by patients. OBJECTIVE: Cost-effectiveness was assessed for vaginal sacrospinous hysteropexy with a polypropylene graft versus vaginal hysterectomy with bilateral uterosacral ligament suture apical suspension. STUDY DESIGN: A prospective economic evaluation was performed concurrent with the Study of Uterine Prolapse Procedures Randomized Trial, conducted April 2013 through February 2020. Participants included 168 postmenopausal women requesting vaginal surgery for symptomatic uterovaginal prolapse. The analysis was from the U.S. health care sector perspective, with a 5-year time horizon. Costs were in 2020 U.S. dollars, with health care unit costs assigned from the 2020 Medicare Fee Schedule and Hospital Outpatient Prospective Payment System. Effectiveness was measured using quality-adjusted life years (QALYs) calculated from the Short-Form Six-Dimension (SF-6D) and the rate of sustained surgical treatment success at 5 years. RESULTS: Costs and QALYs did not differ between treatment groups: costs were $11,631 (95% CI, $8,257, $15,005) hysteropexy versus $12,622 (95% CI, $10,172, $15,072) hysterectomy (P=0.64); and QALYs totaled 3.77 (95% CI, 3.67, 3.87) hysteropexy versus 3.77 (95% CI, 3.66, 3.87) hysterectomy (P=0.99). The cost-effectiveness point estimate was dominant for hysteropexy over hysterectomy. However, at a willingness-to-pay threshold of $150,000 per QALY, the probability that hysteropexy is cost-effective compared with hysterectomy was only 53%. CONCLUSIONS: While hysteropexy had a lower failure rate through 5 years compared with hysterectomy, the surgical treatments provide similar economic value for women with symptomatic uterovaginal prolapse.