For a study, researchers sought to determine the cost-effectiveness of doing standard concurrent apical support treatments during hysterectomy for benign causes. They created a Markov decision model from the standpoint of the health care industry to compare contemporaneous apical support (ie, McCall Coloplast) at the time of hysterectomy for benign causes versus hysterectomy alone. For three years, they modeled Markov transitions between asymptomatic, prolapse without therapy, and treated prolapse states. The primary outcome was the incremental cost-effectiveness ratio, which was defined as the difference in mean cost (2019 US dollars) between groups divided by the difference in mean quality-adjusted life-years (QALYs). Estimates for model parameters were derived from the medical literature. Medicare reimbursement rates and the literature were used to generate cost estimates. They ran one-way, two-way, and probabilistic sensitivity assessments. 

They considered a base-case scenario of 13% post-hysterectomy prolapse following hysterectomy alone and 2.1% after concomitant apical support, with 5.8 and 0.9% needing future surgical treatment for prolapse, respectively. Concurrent apical support was more expensive ($1,667 vs $1,423) but more effective (2.34 vs 2.31 QALYs) than hysterectomy alone. Concurrent apical support was financially efficient, with an increased cost-effectiveness ratio of $11,988/QALY vs broad willingness-to-pay ranges of $50,000–150,000/QALY. Concurrent apical support remained cost-efficient in sensitivity studies as long as the rate of post-hysterectomy prolapse following concurrent apical support was less than 8.7%. In more than 60% of the simulated iterations, the Monte Carlo simulation revealed that concurrent apical support was cost-effective.

At three years, apical support during hysterectomy for benign causes was more cost-efficient than hysterectomy alone in the health care industry. The findings indicated that promoting concurrent apical support treatments during hysterectomy was a cost-effective technique for reducing post-hysterectomy vaginal prolapse.

Reference:journals.lww.com/greenjournal/Abstract/2022/05000/Apical_Support_Procedures_at_the_Time_of.11.aspx