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Effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training in older women with pelvic organ prolapse: 2-year follow-up of a randomized controlled trial in primary care
Open accessAbstract
Objective: We investigated the effectiveness and cost-effectiveness of pessary treatment compared with pelvic floor muscle training (PFMT) in women with pelvic organ prolapse over a 2-year period. Methods: Randomized controlled trial with women (≥55 y) with symptomatic pelvic organ prolapse, identified by screening. Participants were recruited from 20 primary care practices (October 2009-December 2012). Primary outcome was the difference in change of pelvic floor symptoms (PFDI-20 score) between groups over 24 months. Secondary outcomes included prolapse, urinary, and anorectal symptoms; quality of life; costs; sexual functioning; prolapse stage; pelvic floor muscle function; and participants’ perceived symptom improvement. Results: There was a nonsignificant difference in the primary outcome between pessary treatment (n = 82) and PFMT (n = 80) with a mean difference of −3.7 points (95% CI, −12.8 to 5.3; P = 0.42) in favor of pessary treatment. A significantly greater improvement in the prolapse symptom score was, however, seen with pessary treatment (mean difference −3.2 points [95% CI, −6.3 to −0.0; P = 0.05]). Direct medical costs over the 2-year study were $309 and $437 per person for pessary treatment and PFMT, respectively. Conclusions: In older women with symptomatic prolapse, there was no significant difference between pessary treatment and PFMT in reducing pelvic floor symptoms, but specific prolapse-related symptoms did improve more with pessary treatment. Pessary treatment was preferable in the cost-effectiveness analysis. When counseling women for prolapse treatment it should, however, be taken into account that pessary fitting fails in a considerable portion of women and that pessary treatment was associated with more side effects compared with PFMT.
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Metadata
- Authors
- Panman, C. M. C. R., Wiegersma, M., Kollen, B. J., Berger, M. Y., Lisman-van Leeuwen, Y., Vermeulen, K. M., & Dekker, J. H.
- Affiliations
- Department of General Practice
- University Medical Center Groningen (NL)
- Corresponding author
- Dekker, Janny H.
- Venue
- Menopause
- Published
- 2016-12
- Volume
- 23
- Issue
- 12
- Pages
- 1307-1318
- ISSN
- 1072-3714 (ISSN-L)
- 1530-0374
- OpenAlex
- W2513095721
- Cited by
- 61
- References
- 49
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 7 · 2023: 5 · 2022: 8 · 2021: 11 · 2020: 11 · 2019: 2 · 2018: 4 · 2017: 3
- FWCI
- 3.19
- Type
- journal article
- Language
- en
- Open access
- green
- research.rug.nl
- Licence
- other-oa
- Locations
- Menopause The Journal of The North American Menopause Society (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- ZonMw (4201.1001)
- Topics
- Health Sciences › Medicine › Urology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Psychiatry and Mental health › Sexual function and dysfunction studies
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- pelvic organ prolapse, pessary, pelvic floor muscle training, older women, cost-effectiveness, pelvic floor symptoms, PFDI-20, urinary symptoms, anorectal symptoms, quality of life, sexual function, primary care
- MeSH terms
- Aged, Cost-Benefit Analysis, Exercise Therapy, Female, Follow-Up Studies, Humans, Middle Aged, Pessaries, Primary Health Care, Treatment Outcome, Pelvic Floor, Pelvic Organ Prolapse
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