A decision-analytic Markov model to compare the cost-utility of anterior repair augmented with synthetic mesh compared with non-mesh repair in women with surgically treated prolapse.

Abstract

To assess the cost-effectiveness of a mesh-augmented anterior vaginal wall repair compared with a non-mesh fascial plication repair. Cost-utility analysis. Data for outcomes of different surgical techniques were derived from systematic reviews and recent publications. 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. Health outcomes were expressed in terms of quality-adjusted life years (QALYs). 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. This model suggests that the use of mesh is not cost-effective.