. 2021 May 6;21(3):1–155.

Table 22:

Results of Economic Literature Review—Summary

Author, Year, Country of Publication	Analytic Technique, Study Design, Perspective, Time Horizon	Population	Intervention(s) and Comparator(s)	Results
Author, Year, Country of Publication	Analytic Technique, Study Design, Perspective, Time Horizon	Population	Intervention(s) and Comparator(s)	Health Outcomes	Costs	Cost-Effectiveness (ICER, USD/QALY)
Pelvic Organ Prolapse
Hullfish et al, 2011⁵³ United States	Cost–utility analysis Decision analytic model (Markov) Perspective not specified 1-y time horizon No discounting	Post-hysterectomy females with at least stage III apical prolapse of the vagina Mean age: 65 y	Expectant management Pessary VRS Traditional ASC surgery Robot-assisted ASC surgery	Total QALYs: Pessary = 0.867 VRS = 0.95	2007 USD Pessary = $10,000 VRS = $15,000	VRS vs. pessary = $60,240 Pessaries and VRS dominate all other interventions
Panman et al, 2016⁴¹ Netherlands	Cost–utility analysis Randomized controlled trial Perspective not specified 2-y follow-up No discounting	162 women (82 pessary, 80 PFMT) At least 55 y of age, with symptomatic prolapse Mean age (y): Pessary = 64.9 PFMT = 65.6	Pessary PFMT	Total QALYs:^a Pessary = −0.024 PFMT = −0.065	2015 USD Direct medial costs: Pessary = $309 PFMT = $437 Mean difference = $128 (95% CI: 2–236)	Bootstrapped = −$27,439 (95% CI: −91,974 to 74,695)
Stress Urinary Incontinence
Richardson et al, 2014⁵⁴ United States	Cost–utility analysis Decision analytic model (decision tree) Third-party payer perspective 1-y time horizon No discounting	Women with uncomplicated symptomatic SUI Mean age 50 y	Pessary PFMT MUS	QALYs not provided	2012 USD Costs not provided	MUS vs. PFMT = $32,132
Simpson et al, 2019⁵⁵ Canada	Cost–utility analysis Decision analytic model (decision tree) Health system perspective 1-y time horizon No discounting	Healthy adult women at least 18 y of age, with predominant symptoms of SUI Mean age not specified	Pessary PFMT Uresta Impressa	Total QALYs: Pessary = 0.8580 PFMT = 0.8941 Uresta = 0.8818 Impressa = 0.8863	2017 USD Pessary = $55 PFMT = $609 Uresta = $304 Impressa = $347	Uresta vs. Pessary = $43,785 Impressa vs. Uresta = $43,970 PFMT vs Impressa = $44,098
Von Bargen et al, 2015⁵⁶ United States	Cost–utility analysis Decision analytic model (Markov) Societal perspective Lifetime time horizon 3% discount rate	Healthy women with SUI Mean age: 45 y	Conservative management Pessary PFMT PFMT with electrical stimulation MUS	Total QALYs: Pessary = 18.98 MUS = 18.94	2012 USD Pessary = $11,411 MUS = $17,779	Pessary dominates. In CEAC, pessary is the most cost-effective below $50,000/QALY, while at $60,000/QALY and above MUS is the most cost-effective

Abbreviations: ASC, abdominal sacrocolpopexy; CEAC, cost-effectiveness acceptability curve; MUS, midurethral sling; ICER, incremental cost-effectiveness ratio; PFMT, pelvic floor muscle training; QALY, quality adjusted life years; SUI, stress urinary incontinence; VRS, vaginal reconstructive surgery.

We caution any interpretation in the authors published results as they likely derived their incremental QALYs as the utility change.