Abdominal sacral colpopexy versus sacrospinous ligament fixation: a cost-effectiveness analysis
Abstract
Introduction and hypothesis For the surgical correction of apical prolapse the abdominal approach is associated with better outcomes; however, it is more expensive than the transvaginal approach. This cost-effectiveness analysis compares abdominal sacral colpopexy (ASC) with sacrospinous ligament fixation (SSLF) to determine if the improved outcomes of ASC justify the increased expense.Methods A decision-analytic model was created comparing ASC with SSLF using data-modeling software, TreeAge Pro (2013), which included the following outcomes: post-operative stress urinary incontinence (SUI) with possible mid-urethral sling (MUS) placement, prolapse recurrence with possible re-operation, and post-operative dyspareunia. Cost-effectiveness was defined as an incremental cost-effectiveness ratio (ICER) of less than $50,000 per quality-associated life year (QALY). Base-case, threshold, and one-way sensitivity analyses were performed.Results At the baseline, ASC is more expensive than SSLF ($13,988 vs $11,950), but is more effective (QALY 1.53 vs 1.45) and is cost-effective (ICER $24,574/QALY) at 2 years. ASC was not cost-effective if the following four thresholds were met: the rate of post-operative SUI was above 36 % after ASC or below 28 % after SSLF; the rate of MUS placement for post-operative SUI was above 60 % after ASC or below 13 % after SSLF; the rate of recurrent prolapse was above 15 % after ASC or below 4 % after SSLF; the rate of post-operative dyspareunia was above 59 % after ASC or below 19 % after SSLF.Conclusions Abdominal sacral colpopexy can be cost-effective compared with sacrospinous ligament fixation; however, as the post-operative outcomes of SSLF improve, SSLF can be considered a cost-effective alternative.
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Sacrospinous ligament fixation is a safe, low-cost, and effective procedure in the management of apical prolapse.
“Studies have shown sacrospinous ligament fixation as a safe, low-cost, and effective procedure in the management of apical prolapse [9,14-17].”
From Recurrence Rate and Risk Factors for Apical Prolapse After Sacrospinous Ligament Fixation: A Prospective Cohort Study (2026) · cites this paper as [14]
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Favre-Inhofer, A., Carbonnel, M., Murtada, R., Revaux, A., Asmar, J., & Ayoubi, J.-M. (2021) · BMC Women's Health · doi:10.1186/s12905-021-01195-7 · Cited by 17 · see citing works
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- Authors
- Ohno, M. S., Richardson, M. L., & Sokol, E. R.
- Affiliations
- Stanford Medicine (US)
- Corresponding author
- Ohno, Mika S.
- ORCID
- Sokol, Eric R.
- Venue
- International Urogynecology Journal
- Published
- 2015-08-19
- Volume
- 27
- Issue
- 2
- Pages
- 233-237
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- OpenAlex
- W1581235769
- Cited by
- 11
- References
- 19
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 1 · 2021: 1 · 2020: 1 · 2017: 1 · 2016: 1
- FWCI
- 0.56
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Urogynecology Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- sacrospinous ligament fixation, apical pelvic organ prolapse, cost-effectiveness, stress urinary incontinence, midurethral sling, prolapse recurrence, dyspareunia, quality-adjusted life years
- MeSH terms
- Cost-Benefit Analysis, Decision Support Techniques, Dyspareunia, Female, Humans, Ligaments, Recurrence, Gynecologic Surgical Procedures, Urinary Incontinence, Stress, Vagina, Quality-Adjusted Life Years, Suburethral Slings, Pelvic Organ Prolapse
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