Cost-effectiveness of urodynamic testing before surgery for women with pelvic organ prolapse and stress urinary incontinence

OBJECTIVE: This study was undertaken to compare cost-effectiveness between 2 preoperative testing strategies for women with pelvic organ prolapse and stress urinary incontinence symptoms. STUDY DESIGN: We developed decision-analytic models that evaluated the cost -effectiveness of basic office evaluation before surgery in women with prol apse and stress urinary incontinence symptoms and contrasted ii with that o f urodynamic testing. Costs were obtained from the Federal Register; effect iveness of treatment for urinary incontinence was based on the published li terature. RESULTS: The strategies of basic office evaluation and urodynamic testing h ad the same cure rate of urinary incontinence (96%) after initial and secon dary treatment. Under baseline assumptions incremental cost-effectiveness ( cost for single extra cure of urinary incontinence) of urodynamic testing w as $328,601. According to sensitivity analyses, basic office evaluation was more cost-effective than urodynamic testing when the prevalence of pure de trusor instability was <8% or when the cost of urodynamic testing was >$103 . CONCLUSION: Urodynamic testing before surgery in women with prolapse and st ress urinary incontinence symptoms is not cost-effective relative to basic office evaluation.