Related Experiment Video
Updated: Jul 12, 2026
Laparoscopic Non-Mesh Cerclage Pectopexy with Uterine Preservation for Pelvic Organ Prolapse
Published on: October 25, 2024
Cost-effectiveness of Total Versus Supracervical Hysterectomy at Sacrocolpopexy
Lauren A Cadish1, Shannon L Wallace2, Roberto Vargas3
1Department of Obstetrics and Gynecology, Division of Urogynecology, Los Angeles General Medical Center and University of Southern California, Los Angeles, CA.
Importance:
Cervical preservation versus removal is commonly debated among urogynecologists performing sacrocolpopexy (SCP), the gold standard reconstructive procedure for prolapse. A randomized controlled trial is unlikely to ever be performed.
Objective:
The objective was to compare the cost-effectiveness of total (TLH) versus supracervical (SCH) hysterectomy at the time of SCP.
Study Design:
Markov microsimulation evaluated 5-year outcomes after SCP with TLH or SCH. Route-specific complications included bladder/ureteral injury, cuff dehiscence, port-site hernia, mesh exposure, prolapse recurrence with or without retreatment, and occult uterine cancer. Quality-adjusted life years (QALYs) incorporated recovery, prolapse recurrence, and cancer treatment states with an annual 3% discount rate. Probabilistic sensitivity analysis (PSA, n=10,000) assessed model uncertainty.
Results:
Median costs were SCP/TLH=$16,117.50, SCP/SCH=$16,078.00 (Δ=$39.50, 0.2%). Median effectiveness was 4.65 QALYs for both. PSA showed TLH was more effective in 15.8%, SCH in 17.3%, with equal effectiveness in 67.0%. Net monetary benefit (NMB) favored SCH by $39.50 (<0.01% of total NMB).
Conclusions:
While risks vary between TLH and SCH, rare and mostly balanced complications, similar costs, and high efficacy regardless of route explain why both approaches perform equally overall.
