Cost of pelvic organ prolapse surgery in the United States

OBJECTIVE: To estimate the annual direct cost to society of pelvic organ prolapse operations in the United States. METHODS: We multiplied the number of pelvic organ prolapse operations identified in the 1997 National Hospital Discharge Survey by national average Medicare reimbursement for physician services and hospitalizations. Although this reimbursement does not estimate the actual cost, it is a proxy for cost, which estimates what society pays for the procedures. RESULTS: In 1997, direct costs of pelvic organ prolapse surgery were $1012 million (95% confidence interval [CI] $775, 1251 million), including $494 million (49%) for vaginal hysterectomy, $279 million (28%) for cystocele and rectocele repair, and $135 million (13%) for abdominal hysterectomy. Physician services accounted for 29% ($298 million) of total costs, and hospitalization accounted for 71% ($714 million). Twenty-one percent of pelvic organ prolapse operations included urinary incontinence procedures ($218 million). If all operations were reimbursed by non-Medicare sources, the annual estimated cost would increase by 52% to $1543 million. CONCLUSION: The annual direct costs of operations for pelvic organ prolapse are substantial.