{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T15:40:49Z","timestamp":1781624449625,"version":"3.54.5"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T00:00:00Z","timestamp":1693872000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Our objective was to perform a 5\u2010year cost\u2010effectiveness analysis of transvaginal hysteropexy (HP) via sacrospinous ligament fixation (SS) or uterosacral ligament suspension (US) versus vaginal hysterectomy (VH) with apical suspension via sacrospinous ligament fixation (SS) or uterosacral ligament suspension (US) for the treatment of uterine prolapse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A decision analytic model assessed the cost\u2010effectiveness of the surgical intervention over a 5\u2010year horizon.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>This model was constructed using TreeAge\u00ae software.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population or Sample<\/jats:title><jats:p>Healthy women undergoing surgery for uterine prolapse were modeled.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A Markov model was constructed to simulate the possible recurrence of prolapse. Recurrence rates, repeat surgery for surgical failures and complication rates were modeled. Base case, sensitivity analyses and probabilistic modeling were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measures<\/jats:title><jats:p>The primary outcome was the incremental cost\u2010effectiveness ratio (ICER) of &lt;$100\u2009000 per quality\u2010adjusted life year (QALY).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Using the available prolapse recurrence rates and repeat surgery rates in the literature, both HP\u2010SS and HP\u2010US are cost\u2010effective at a willingness\u2010to\u2010pay (WTP) threshold of &lt;$100\u2009000 per QALY. The incremental cost\u2010effectiveness ratio (ICER) for HP\u2010US compared to HP\u2010SS is $90\u2009738.14, while VH\u2010US and VH\u2010SS are both dominated strategies. HP\u2010US is the optimal cost\u2010effective strategy but decays exponentially with increasing probability of prolapse recurrence and need for repeat surgery after failed hysteropexy. The cost\u2010effectiveness acceptability curve (CEAC) favors sacrospinous hysteropexy until reaching a WTP threshold between $90\u2009000 and $100\u2009000.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Hysteropexy surgical strategies are cost\u2010effective transvaginal surgical approaches for uterine prolapse. Vaginal hysterectomy with apical suspension becomes more cost\u2010effective with increasing probability of prolapse recurrence and need for repeat surgery after failed hysteropexy. Given the variability of prolapse recurrence rates in the literature, more comparative studies are needed to understand the cost\u2010effectiveness relationship between these different surgical approaches.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.17642","type":"journal-article","created":{"date-parts":[[2023,9,5]],"date-time":"2023-09-05T07:27:50Z","timestamp":1693898870000},"page":"362-371","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Vaginal hysteropexy compared with vaginal hysterectomy with apical suspension for the treatment of pelvic organ prolapse: A 5\u2010year <scp>cost\u2010effectiveness<\/scp> Markov model"],"prefix":"10.1111","volume":"131","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1112-9593","authenticated-orcid":false,"given":"Shannon L.","family":"Wallace","sequence":"first","affiliation":[{"name":"Division of Urogynecology and Pelvic Floor Disorders Department of Obstetrics and Gynecology Ob\/Gyn &amp; Women's Health Institute Cleveland Clinic Foundation  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4020-8004","authenticated-orcid":false,"given":"Raveen","family":"Syan","sequence":"additional","affiliation":[{"name":"Division of Female Urology and Urogynecology Department of Urology Desai Sethi Medical Institute University of Miami  Miami Florida USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyueun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Pharmacy School of Pharmacy University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric R.","family":"Sokol","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Reconstructive Pelvic Surgery Department of Obstetrics and Gynecology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,5]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-009-0902-1"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(97)00058-6"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000000286"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0029-7844(01)01472-7"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-14-1128"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l5149"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.h3717"},{"issue":"4","key":"e_1_2_12_9_1","first-page":"e46","article-title":"A cost\u2010effectiveness analysis of vaginal Hysteropexy compared to vaginal hysterectomy with apical suspension for the treatment of Pelvic organ prolapse","volume":"203","author":"Syan R","year":"2020","journal-title":"J Urol"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1537-2995.1991.31491213295.x"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2020.06.032"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jogc.2016.12.008"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2018.11.1094"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-015-2819-1"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.4236\/ojog.2013.38110"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001981"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001442"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-019-03876-2"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa013336"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.1719"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1405158"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2010.164"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-009-1014-7"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00192-007-0520-8"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/SPV.0000000000000403"}],"container-title":["BJOG: An International Journal of Obstetrics &amp; 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