Previously, the cost of pelvic organ prolapse (POP) surgery in the United Stated (US) had been evaluated using the National Hospital Discharge Survey to estimate the direct costs of pelvic organ prolapse surgery nationwide in 2001, which estimated the cost to be over 1 billion dollars. More recent studies have assessed racial disparities and geographic variance in costs associated with gynecologic and POP surgeries, but these studies only evaluated costs associated with inpatient surgeries. We recognize that surgical method and setting has changed significantly over the last 25 years. Our goal is to obtain an updated estimate of the national cost and understand the population receiving POP surgery both in the inpatient and ambulatory setting.

In this cross-sectional, population-based study, we used the 2016 to 2018 Healthcare Cost and Utilization Project (HCUP) National Inpatient Samples and National Ambulatory Surgery Sample to identify all female adult patients undergoing POP surgery, identified by ICD-10-PCS and CPT codes. Descriptive analysis was used to identify the socio-demographic and clinical characteristics of the national population undergoing POP surgery. A cost-to-charge ratio and weighted estimates  were used to calculate nationwide costs. Three years of data were used in order to minimize any single year outlier to develop a more comprehensive estimate. All costs were transformed into 2023 dollars using the US medical consumer price index.

Between 2016 and 2018, 45.0% of the total US population receiving prolapse surgery were less than 50, and the average age of the total population was 51.6 years. Patients were most likely to have private insurance (50.5%), with 29.2% using Medicare and 16.5% using Medicaid as the primary payor. There was a greater distribution of patients receiving pelvic organ prolapse surgery in the US South (38.6%), with the Northeast having the fewest surgeries nationally (14.9%). The most common comorbidities were hypertension (27.8%), diabetes (10.1%), obesity (10.3%), and pulmonary disease (9.5%). Overall, 53.6% of the total surgeries occurred in the outpatient setting. 

The annual national cost was estimated as $4,667,714,251 per year. The average cost per procedure increased from $16,286 in 2016 to $18,090 in 2018. Greater than half of the total national cost associated with pelvic organ prolapse surgery came from the ambulatory setting, with a total cost of $2.96 billion from ambulatory in 2018 compared to $1.94 billion from inpatient.

The US annual national cost associated with pelvic organ prolapse surgery continues to rise significantly since last evaluated and is now over $4.5 billion USD per year. At this time, the proportion of the population receiving this care in an outpatient setting, and the costs incurred are greater than that receiving surgery inpatient.

The US annual national cost associated with pelvic organ prolapse surgery continues to rise, and the majority now receive surgery in an ambulatory setting. Therefore, any future analysis evaluating pelvic organ prolapse surgery at a population level should also include the outpatient surgical population.

Subak, L.L., et al., Cost of pelvic organ prolapse surgery in the United States. Obstet Gynecol, 2001. 98(4): p. 646-51

Continence 7S1 (2023) 100854
DOI: 10.1016/j.cont.2023.100854