1391 MESH KITS FOR ANTERIOR VAGINAL PROLAPSE (AVP) ARE NOT COST EFFECTIVE

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Pelvic Prolapse1 Apr 20101391 MESH KITS FOR ANTERIOR VAGINAL PROLAPSE (AVP) ARE NOT COST EFFECTIVE Sunshine Murray, Rashel Haverkorn, Yair Lotan, and Gary Lemack Sunshine MurraySunshine Murray More articles by this author , Rashel HaverkornRashel Haverkorn More articles by this author , Yair LotanYair Lotan More articles by this author , and Gary LemackGary Lemack More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1041AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES With rising health care costs, cost-effective medicine has been pushed to the forefront. We attempt to analyze the cost of three common forms of AVP repair. METHODS A meta-analysis was performed to obtain average operating room (OR) times, mesh extrusion and recurrence rates for traditional anterior colporrhaphy (AC), hand cut mesh and mesh kit AVP repair. Medicare reimbursement for surgeon fees and office visits, and hospital cost of prolene mesh, mesh kits, OR time, recovery room stay, intravenous fluids and room and board were obtained. OR time for mesh excision was obtained by averaging the times of cases performed at our hospital over the last two years. RESULTS Weighted operative times for mesh kit, mesh non-kit and AC were 58, 64 and 79 minutes respectively. Weighted extrusion rates and recurrence rates for mesh kit and mesh non-kit were 11%/10% and 13%/14%. We estimated recurrence rate at 30% for AC. The professional fee for mesh repair is $895 compared to $630 for AC. The cost of a mesh kit averages $1648 and the cost of a 12x14cm piece of mesh is $400. OR time at our hospital is $13 per minute, with additional overnight costs of $825. Cost of extrusion was calculated assuming 1 additional clinic visit, using the professional fee for mesh excision ($476) and the average OR time for mesh excision (47m). The cost of recurrence was calculated assuming non-kit mesh repair performed at 1.5x initial OR time with an overnight stay. The cost of non-kit mesh repair was $3380, AC was $3461 and mesh kit $4678. When performing one-way sensitivity analyses, the recurrence rate of the traditional repair would need to be 28% to be equally cost-effective. The mesh kit repair did not reach equal cost with either repair even at an OR time of 0 minutes. A two-way sensitivity analysis was performed comparing mesh extrusion and AC recurrence (see figure). At a recurrence rate of up to 20%, AC is more cost effective. When the recurrence rate for AC is 30%, the mesh non-kit repair is more cost effective if the extrusion rate is less than 25%. If recurrence rate is calculated at 50% then hand cut mesh is more cost effective even with a 50% extrusion rate. CONCLUSIONS Mesh kits for repair of AVP are not cost effective, regardless of the time saving in the OR or reduction in recurrence. Non-kit mesh is cost effective for AVP if extrusion rates remain below 25%. Dallas, TX© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e537-e538 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sunshine Murray More articles by this author Rashel Haverkorn More articles by this author Yair Lotan More articles by this author Gary Lemack More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...