(Poster 21) Minimally Invasive Sacrohysteropexy versus Sacrocolpopexy: A Cost Analysis

Objectives: To compare the cost-effectiveness of minimally invasive supracervical hysterectomy with sacrocolpopexy versus minimally invasive sacrohysteropexy.

Methods: A decision tree model using TreeAge software was developed to evaluate the cost-effectiveness of minimally invasive supracervical hysterectomy with sacrocolpopexy compared to uterine-sparing minimally invasive sacrohysteropexy. Effectiveness was expressed in quality-adjusted life years, and the willingness to pay threshold was set to $100,000 per quality-adjusted life years gained or lost. Literature review was performed to obtain probabilities, utilities, and cost data, including costs for minimally invasive supracervical hysterectomy, minimally invasive sacrohysteropexy, endometrial biopsy, and hysteroscopy, pelvic ultrasound, blood transfusion, vaginal mesh exposure, hysterectomy and cancer treatment with Gynecologic Oncology, endometrial cancer and end of life care. Incidence and diagnostic evaluation of postmenopausal bleeding, risk of endometrial pathology, and endometrial cancer were modeled. We estimated the incremental cost effectiveness ratio between the two strategies, completed a probabilistic sensitivity analysis with 10,000 simulations, and created a cost-effectiveness acceptability curve for willingness to pay thresholds from $0 to $200,000. Secondary outcomes included numbers of additional major surgeries, endometrial cancer cases, and endometrial cancer deaths.

Results: Minimally invasive sacrohysteropexy demonstrated absolute dominance over minimally invasive supracervical hysterectomy with sacrocolpopexy. For a cohort of 10,000, minimally invasive sacrohysteropexy is associated with an additional 255 major surgeries, 5 endometrial cancer cases, and 2 endometrial cancer deaths. Probabilistic sensitivity analysis revealed the chance of minimally invasive sacrohysteropexy being more cost-effective was 54.9% at a willingness to pay threshold of $100,000 and 52.7% at a willingness to pay threshold of $200,000.

Conclusions: Our model suggests that minimally invasive sacrohysteropexy is more cost-effective compared to minimally invasive supracervical hysterectomy with sacrocolpopexy. However, minimally invasive supracervical hysterectomy with sacrocolpopexy decreases the number of additional major surgeries, endometrial cancer diagnoses, and endometrial cancer deaths.

Figure 1. Decision Tree Structure
Decision tree comparing the cost-effectiveness of minimally invasive sacrohysteropexy versus minimally invasive supracervical hysterectomy with sacrocolpopexy. Abbreviations: MIH-SCP = minimally invasive supracervical hysterectomy with sacrocolpopexy, MISH = minimally invasive sacrohysteropexy, PMB = postmenopausal bleeding, US = ultrasound, EMS = endometrial stripe, EMB = endometrial biopsy, HSC = hysteroscopy, D&C = dilation & curettage.

Figure 2. Probabilistic Sensitivity Analysis with Cost-Effectiveness Acceptability Curve
The cost-effectiveness acceptability curve illustrates the probability that different strategies would be deemed cost-effective across various willingness-to-pay thresholds. At a willingness-to-pay threshold of $100,000, minimally invasive sacrohysteropexy was preferred in 54.9% of iterations, while it was favored in 52.7% of cases at a threshold of $200,000.