Primary surgical management of anterior pelvic organ prolapse: a systematic review, network meta-analysis and cost-effectiveness analysis

Slade, E., Daly, C., Mavranezouli, I., Dias, S., Kearney, R., Hasler, E., Carter, P., Mahoney, C., Macbeth, F. and Delgado Nunes, V. 2020. Primary surgical management of anterior pelvic organ prolapse: a systematic review, network meta-analysis and cost-effectiveness analysis. BJOG: An International Journal of Obstetrics and Gynaecology 127 (1) , p. 26. 10.1111/1471-0528.15959

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Abstract

Background Anterior compartment prolapse is the most common pelvic organ prolapse (POP) with a range of surgical treatment options available. Objectives To compare the clinical effectiveness and cost-effectiveness of surgical treatments for the repair of anterior POP. Methods We conducted a systematic review of randomised controlled trials comparing surgical treatments for women with POP. Network meta-analysis was possible for anterior POP, same-site recurrence outcome. A Markov model was used to compare the cost–utility of surgical treatments for the primary repair of anterior POP from a UK National Health Service perspective. Main results We identified 27 eligible trials for the network meta-analysis involving eight surgical treatments tested on 3194 women. Synthetic mesh was the most effective in preventing recurrence at the same site. There was no evidence to suggest a difference between synthetic non-absorbable mesh, synthetic partially absorbable mesh, and biological mesh. The cost–utility analysis, which incorporated effectiveness, complications and cost data, found non-mesh repair to have the highest probability of being cost-effective. The conclusions were robust to model inputs including effectiveness, costs and utility values. Conclusions Anterior colporrhaphy augmented with mesh appeared to be cost-ineffective in women requiring primary repair of anterior POP. There is a need for further research on long-term effectiveness and the safety of mesh products to establish their relative cost-effectiveness with a greater certainty. Tweetable abstract New study finds mesh cost-ineffective in women with anterior pelvic organ prolapse.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine Centre for Trials Research (CNTRR)
Publisher:	Wiley
ISSN:	1470-0328
Date of First Compliant Deposit:	28 April 2022
Date of Acceptance:	9 September 2020
Last Modified:	06 Nov 2024 23:45
URI:	https://orca.cardiff.ac.uk/id/eprint/149421

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