P Jacklin1, J Duckett1. 1. National Collaborating Centre for Women's and Children's Health, London, UKDepartment of Obstetrics and Gynaecology, Medway NHS Foundation Trust, Gillingham, Kent, UK.
Abstract
OBJECTIVES: To assess the cost-effectiveness of a mesh-augmented anterior vaginal wall repair compared with a non-mesh fascial plication repair. DESIGN: Cost-utility analysis. SETTING: Data for outcomes of different surgical techniques were derived from systematic reviews and recent publications. METHODS: A decision-analytic Markov model, developed in TreeAge Pro 2007(®) , was used to compare the cost-utility of mesh and non-mesh anterior vaginal wall repairs. Sensitivity analysis was used to assess the impact of different scenarios and assumptions on results from the model. MAIN OUTCOME MEASURE: Health outcomes were expressed in terms of quality-adjusted life years (QALYs). RESULTS: Under base case assumptions at 5 years, the incremental cost-effectiveness ratio (ICER) for mesh-augmented anterior repairs was £15 million per QALY. Sensitivity analysis found no plausible model inputs that could make a mesh repair cost-effective by conventional criteria. This was mostly because of the extra costs associated with the price of the mesh, treating mesh erosion and difficulty finding data that support a lower reoperation rate for mesh anterior wall repairs. CONCLUSIONS: This model suggests that the use of mesh is not cost-effective.
OBJECTIVES: To assess the cost-effectiveness of a mesh-augmented anterior vaginal wall repair compared with a non-mesh fascial plication repair. DESIGN: Cost-utility analysis. SETTING: Data for outcomes of different surgical techniques were derived from systematic reviews and recent publications. METHODS: A decision-analytic Markov model, developed in TreeAge Pro 2007(®) , was used to compare the cost-utility of mesh and non-mesh anterior vaginal wall repairs. Sensitivity analysis was used to assess the impact of different scenarios and assumptions on results from the model. MAIN OUTCOME MEASURE: Health outcomes were expressed in terms of quality-adjusted life years (QALYs). RESULTS: Under base case assumptions at 5 years, the incremental cost-effectiveness ratio (ICER) for mesh-augmented anterior repairs was £15 million per QALY. Sensitivity analysis found no plausible model inputs that could make a mesh repair cost-effective by conventional criteria. This was mostly because of the extra costs associated with the price of the mesh, treating mesh erosion and difficulty finding data that support a lower reoperation rate for mesh anterior wall repairs. CONCLUSIONS: This model suggests that the use of mesh is not cost-effective.