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Primary surgical management of anterior pelvic organ prolapse: a systematic review, network meta-analysis and cost-effectiveness analysis.
BJOG ; 127(1): 18-26, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31538709
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.
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Texto completo: Disponível Coleções: Bases de dados internacionais Base de dados: MEDLINE Assunto principal: Procedimentos Cirúrgicos em Ginecologia / Telas Cirúrgicas / Prolapso de Órgão Pélvico Tipo de estudo: Avaliação econômica em saúde / Revisão sistemática Aspecto clínico: Terapia Limite: Feminino / Humanos Idioma: Inglês Revista: BJOG Assunto da revista: Ginecologia / Obstetrícia Ano de publicação: 2020 Tipo de documento: Artigo País de afiliação: Reino Unido