Mesh kits for anterior vaginal prolapse are not cost effective

Abstract

To analyze the cost-effectiveness of traditional anterior colporrhaphy (AC), hand-cut mesh, and mesh kit anterior vaginal prolapse (AVP) repair. A decision analysis model was built using mean operating room (OR) times, mesh extrusion rates, and recurrence rates obtained from a meta-analysis along with Medicare reimbursement for surgeon fees and office visits, and hospital costs of supplies, OR time, and room and board. Non-kit mesh repair was $3,380, AC $3,461, and mesh kit $4,678. One-way sensitivity analyses demonstrated recurrence rate of AC would need to be 28% to be equally cost effective. Mesh kit repair did not reach cost equivalence even at 0 min OR time. Two-way sensitivity analysis comparing mesh extrusion and AC recurrence demonstrated AC is more cost effective if recurrence is <20% or extrusion >25%. Mesh kits for AVP repair are not cost effective, regardless of the OR time saved.