Cost-Effectiveness of Combined Robotic Rectal Prolapse and Pelvic Organ Prolapse Surgery: 12-Month Results of Multicenter Prospective Robotic Prolapse Surgery Cohort

Document Type

Conference Proceeding

Publication Date

6-2025

Publication Title

International Urogynecology Journal

Abstract

Introduction: Combined rectal prolapse (RP) and pelvic organ prolapse (POP) have a more significant adverse impact on quality of life and are more complex to treat than either condition alone. However, studies evaluating the cost-effectiveness of robotic surgery for treating both RP and POP simultaneously are lacking.

Objective: Our primary objective was to compare the one-year cost-effectiveness of three surgical strategies: combined robotic RP and POP surgery (rRP+rPOP), robotic RP surgery only (rRP), and robotic POP surgery only (rPOP). Our secondary objective was to evaluate 12-month quality of life outcomes for women undergoing treatment for RP, POP, or both.

Methods: This IRB-approved, multicenter, prospective study evaluated the economic impact and quality-of-life improvements over 12 months following robotic prolapse surgery. Three geographically diverse sites recruited women with external RP and/or POP undergoing either rRP, rPOP, or combined rRP+rPOP surgery. Validated surveys assessed bowel and bladder function (Pelvic Floor Distress Inventory [PFDI], Pelvic Floor Impact Questionnaire [PFIQ]), constipation (PACSYM, PACQoL), fecal incontinence (Wexner, Vaizey), mental health (Hospital Anxiety and Depression Scale [HADS]), sexual function (PISQ-IR), and quality of life (EQ-5D-3L, Patient Global Impression of Change [PGIC]). Surveys were electronically distributed at baseline and 12 months post-surgery. Institutional costs for index surgeries, complications, repeat surgeries, and follow-up office visits were calculated in 2024 dollars. Effectiveness was measured in quality-adjusted life years (QALYs) based on the EQ-5D-3L. Incremental cost-effectiveness ratios for rRP, rPOP and, combined rRP+rPOP surgery were then calculated.

Results: Forty-eight women (rRP = 15, rPOP = 17, rRP+rPOP = 16) with similar demographics and comorbidities were included. At 12 months, all three cohorts showed significant symptom improvement over baseline based on the PFDI-20, PFIQ-7, PACSYM, and PACQoL surveys. The rRP and rRP+rPOP cohorts also demonstrated significant improvement in 12-month Wexner, Vaizey, and FIQL scores (Table 1). EQ-5D-3L scores showed age-adjusted mean one year QALY improvements of 0.21 for rRP, 0.06 for rPOP, and 0.15 for rRP+rPOP (Table 2). The rPOP surgery was the least costly, followed by rRP surgery (an additional $10,090 per surgery per year), and then combined rRP+rPOP surgery (an additional $16,693). Both rRP and rPOP surgeries were cost-effective, remaining below the willingness-to-pay (WTP) threshold of $100,000 per QALY. The incremental cost-effectiveness ratio (ICER) for rRP compared to rPOP was $67,266.67. The combined rRP+rPOP surgery was a dominated strategy, as it had higher costs with less QALY improvement.

Conclusions: Our one-year study of three surgical cohorts suggests that patients undergoing robotic prolapse surgery experience significant improvements in quality of life, particularly in bowel and bladder function. Our cost-effectiveness analysis shows that both rRP surgery only and rPOP surgery only are cost-effective strategies for treating prolapse. However, combined rRP+rPOP surgery is not cost-effective, with higher costs and less QALY improvement. These results suggest that patients with combined RP and POP should be carefully evaluated for bothersome symptoms. Patients and providers should engage in shared decision-making discussions, particularly regarding asymptomatic prolapse and the risks of overcorrection or unnecessary surgery for combined prolapse. Longer follow-up of this heterogeneous population may better characterize prolapse recurrence and worsening symptoms after surgery.

Volume

36

Issue

Suppl 1

First Page

S81

Comments

IUGA/EUGA (International Urogynecological Association/European Urogynaecological Association) Joint Meeting, June 18-21, 2025, Barcelona, Spain

Last Page

S81

DOI

10.1007/s00192-025-06257-0

ISSN

1433-3023

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