Authors
Lauren A Cadish, Shannon L Wallace, Roberto Vargas, Brad St Martin, Olivia H Chang, Eric R Sokol, Jonathan P Shepherd
Published in
Urogynecology (Philadelphia, Pa.). Jul 07, 2026. Epub Jul 07, 2026.
Abstract
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.
The objective was to compare the cost-effectiveness of total (TLH) versus supracervical (SCH) hysterectomy at the time of SCP.
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.
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).
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.
PMID:
42424599
Bibliographic data and abstract were imported from PubMed on 10 Jul 2026.
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