Table A7:

Assessment of the Applicability of Studies Evaluating the Cost-Effectiveness of Vaginal Pessaries

Author, Year, Country of Publication	Is the study population similar to the question?	Are the interventions similar to the question?	Is the health care system studied sufficiently similar to Ontario?	Were the perspectives clearly stated? If yes, what were they?	Are all direct effects included? Are all other effects included where there is material?	Are all future costs and outcomes discounted? If yes, at what rate?	Is the value of health effects expressed in terms of quality-adjusted life-years?	Are costs and outcomes from other sectors fully and appropriately measured and valued?	Overall Judgmenta
Hullfish et al, 201153 United States	Yes, but narrow population based on prolapse staging	Partially, does not include PFMT	No (United States)	No	Yes	NA, 1-y time horizon	Yes, but utilities were estimated by the authors	No	Partially applicable
Panman et al, 201641 Netherlands	Yes (POP)	Partially, does not include surgery	No (Netherlands)	NA, an RCT was conducted, not an economic model	Yes	No, RCT data	Yes	No	Partially applicable
Richardson et al, 201454 United States	Yes (SUI)	Yes	No (United States)	Yes, third-party payer perspective	Yes	NA, 1-y time horizon	Yes	No	Partially applicable
Simpson et al, 201955 Canada	Yes (SUI)	Partially, does not include surgery	Yes (Canada – not province specific)	Yes, health system perspective	No, pessary fitting costs were not modelled	NA, 1-y time horizon	Yes	No	Partially applicable
Von Bargen et al, 201556 United States	Yes (SUI)	Yes	No (United States)	Yes, societal perspective	Yes	Yes, 3% discount rate	Yes	Yes	Partially applicable

Abbreviations: PFMT, pelvic floor muscle training; POP, pelvic organ prolapse; RCT, randomized controlled trial; SUI, stress urinary incontinence.

Note: Response options for all items were “yes,” “partially,” “no,” “unclear,” and “NA” (not applicable).

^aOverall judgment may be “directly applicable,” “partially applicable,” or “not applicable.”