Economic model demonstrates prophylactic uterosacral ligament suspension during benign hysterectomy is cost-effective with modest risk reduction, supporting selective surgical adoption.
Key Points
To evaluate the costs and cost-effectiveness of routinely adding prophylactic uterosacral ligament suspension to benign hysterectomies to prevent pelvic organ prolapse.
A decision-tree cost-effectiveness model (TreeAge Pro, 2024 U.S. dollars) integrated Medicare Physician Fee Schedules and Diagnosis-Related Group data.
Assigned a health utility of 0.864 for prolapse following hysterectomy with a mean onset of 7 years, applying a 3% discount rate across sensitivity analyses (0–20 years).
Calculated the minimum relative reduction in prolapse risk required for prophylactic suspension to achieve cost-effectiveness at a $100,000 per quality-adjusted life year (QALY) threshold.
Prophylactic uterosacral ligament suspension added $4,992.87 in procedural costs.
The procedure achieved cost-effectiveness at the $100,000/QALY threshold when relative prolapse risk decreased by ≥7.1%, meeting cost-effectiveness criteria in 87.0% of modeled scenarios.
The minimum preventive benefit needed ranged from a 5.8% risk reduction for immediate prolapse onset to 10.5% for onset delayed by 20 years.