P206 - Cost-Effectiveness of Combined Robotic Rectal Prolapse and Pelvic Organ Prolapse Surgery: 12-Month Results of Multicenter Prospective Robotic Prolapse Surgery Cohort

Sunday, May 11, 2025

4:03 PM – 4:09 PM PT

Location: Ballroom 6B, Upper Level

Abstract Podium Presenter(s)

Shannon L. Wallace, MD

Assistant Professor
Cleveland Clinic Obstetrics and Gynecology Institute
Moreland Hills, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

James Ogilvie, Jr., MD

Attending Physician
Corewell Health
MIchigan State University
Grand Rapids, Michigan, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
Liliana Bordeianou, MD, FASCRS

MD
Massachusetts General Hospital, Harvard Medical School
Harvard
Boston, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
RP

Raisa O. Platte, MD, PhD

Assistant Professor
Corewell Health
Grand Rapids, Michigan, United States

Disclosure information not submitted.
MW

Milena M. Weinstein, MD

Professor
Massachusetts General Hospital
Boston, Massachusetts, United States

Disclosure information not submitted.
ES

Eric R. Sokol, MD

Professor
Stanford University School of Medicine
Palo Alto, California, United States

Disclosure information not submitted.
EE

Ekene Enemchukwu, MD, MPH, FACS, URPS

Associate Professsor
Stanford University School of Medicine
Stanford, California, United States

Disclosure information not submitted.
KM

Kavita Mishra, MD

Assistant Professor
Stanford University School of Medicine
Stanford, California, United States

Disclosure information not submitted.

Senior Author(s)

Brooke Gurland, MD, FASCRS, FACS

Clinical Professor of Surgery
Stanford University
Stanford Surgery
MENLO PARK, California, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Submitting Author(s)

Shannon L. Wallace, MD

Assistant Professor
Cleveland Clinic Obstetrics and Gynecology Institute
Moreland Hills, OH, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.

Shannon L. Wallace, MD: This individual has no financial relationships with ineligible companies.

James Ogilvie, MD, Jr.: This individual has no relevant relationships with ineligible companies.

Liliana Bordeianou, MD, FASCRS: This individual has no relevant relationships with ineligible companies.

Brooke Gurland, MD, FASCRS, FACS: This individual has no financial relationships with ineligible companies.

Image or Table (Do Not add text here):

Purpose/Background: Studies evaluating the cost-effectiveness of robotic surgery for treating both rectal prolapse (RP) and pelvic organ prolapse (POP) are lacking. 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/Interventions: This IRB-approved, multicenter, prospective study, funded by ASCRS, 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/Outcomes: 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 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.

Conclusion/Discussion: 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 in our model, with higher costs and less QALY improvement. These results suggest that patients with combined RP and POP should be carefully evaluated for bothersome symptoms, and patients and providers should engage in shared decision-making discussions regarding combined prolapse. This patient population is likely heterogeneous, and further studies with longer follow-up are needed to understand the time course of recurrence and symptom worsening after prolapse surgery.