Premium
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
Author(s) -
Jacklin P,
Duckett J
Publication year - 2013
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.12028
Subject(s) - medicine , markov model , surgical mesh , markov chain , sensitivity (control systems) , surgery , computer science , algorithm , machine learning , engineering , electronic engineering , hernia
Objectives To assess the cost‐effectiveness of a mesh‐augmented anterior vaginal wall repair compared with a non‐mesh fascial plication repair. Design Cost–utility analysis. Setting Data for outcomes of different surgical techniques were derived from systematic reviews and recent publications. Methods A decision‐analytic Markov model, developed in T ree A ge P ro 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. Main outcome measure Health outcomes were expressed in terms of quality‐adjusted life years (QALYs). Results 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. Conclusions This model suggests that the use of mesh is not cost‐effective.