Cost Analysis of the Anterior Vaginal Wall Suspension Procedure to the Repair of Stress Urinary Incontinence with Early Grade Anterior Compartment Prolapse

INTRODUCTION: To evaluate the contemporary cost of the Anterior Vaginal Wall Suspension (AVWS) procedure to correct SUI with early grade compartment prolapsed. METHODS: The cost of AVWS for women undergoing AVWS alone (with no associated procedure) was analyzed from a prospective long-term database. Costing data was obtained from a tertiary care institution for operating room expenses, medical and surgical supplies, pharmacy, anesthesia supplies, and room and bed. Professional fees for the AVWS procedure were obtained from the Medicare Fee for Service Schedule. Costs for 2012 were adjusted by 3% to match 2013 costs. Due to non-normality in the data, the non-parametric Wilcoxon Rank Sum test was used to test for differences in cost by fiscal year or payer type. The Student t-test was used to ensure this population was a representative sample by testing for differences between the patients in this sample compared to the remainder of the patients that have undergone AVWS without concomitant surgery at our institution RESULTS: For 2012 - 2013, 34 of 48 women met inclusion criteria. One charity case was excluded, and others had concomitant procedures like hysterectomy. With the 3% inflation adjustment for 2012, the mean total cost was $3681 ± $764, with a median cost of $3664. Anesthesia, operating room, and room and bed costs differed significantly from 2012 to 2013. Only pharmacy cost differed between payer mix and Medicare. The sample analyzed had a shorter mean surgery time (69.6 min) compared to the overall AVWS population (86 min).). This cost data compares favorably to the average cost reported in contemporary U.S. literature for Tension free vaginal tape (TVT)( $8082 - 9579), transobturator tape (TOT) ($9017), and BC ($9320 - $105450) CONCLUSION: The AVWS mean total cost was $3681, with an increase in cost from 2012 to 2013 related to anesthesia, operating room, and room and bed costs, a figure much lower than most reported costs for comparable anti-incontinence procedures.