Primary surgical management of anterior pelvic organ prolapse: a systematic review, network meta‐analysis and cost‐effectiveness analysis

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 and cost effectiveness of surgical treatments for the repair of anterior POP. // METHODS: We conducted a systematic review of randomised controlled trials (RCTs) comparing surgical treatments for women with POP. Network meta-analysis (NMA) 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 NMA involving eight surgical treatments tested on 3,194 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. // FUNDING: The guideline referred to in this article was produced by the National Guideline Alliance (NGA) at the Royal College of Obstetricians and Gynaecologists (RCOG) for the National Institute for Health and Care Excellence (NICE). The views expressed in this article are those of the authors and not necessarily those of RCOG, NGA or NICE.