干旱区生态环境知识资源中心(Arid): Universal Urogynecologic Consultation and Screening for Fecal Incontinence in Pregnant Women With a History of Obstetric Anal Sphincter Injury: A Cost-Effectiveness Analysis

Arid

DOI	10.1097/SPV.0000000000001267
	Universal Urogynecologic Consultation and Screening for Fecal Incontinence in Pregnant Women With a History of Obstetric Anal Sphincter Injury: A Cost-Effectiveness Analysis
	Swallow, Christina H.; Harvey, Christina N.; Harmanli, Oz; Shepherd, Jonathan P.
通讯作者	Swallow, CH
来源期刊	UROGYNECOLOGY
EISSN	2771-1897
出版年	2023
卷号	29 期号:3 页码:351-359
英文摘要	ImportanceObstetric anal sphincter injuries (OASIS) predispose for the development of fecal incontinence (FI), but management of subsequent pregnancy after OASIS is controversial.ObjectiveWe aimed to determine if universal urogynecologic consultation (UUC) for pregnant women with prior OASIS is cost-effective.Study DesignWe performed a cost-effectiveness analysis of pregnant women with a history of OASIS modeling UUC compared with no referral (usual care). We modeled the route of delivery, peripartum complications, and subsequent treatment options for FI. Probabilities and utilities were obtained from published literature. Costs using a third-party payer perspective were gathered from the Medicare physician fee schedule reimbursement data or published literature converted to 2019 U.S. dollars. Cost-effectiveness was determined using incremental cost-effectiveness ratios).ResultsOur model demonstrated that UUC for pregnant patients with prior OASIS was cost-effective. Compared with usual care, the incremental cost-effectiveness ratio for this strategy was $19,858.32 per quality-adjusted life-year, below the willingness to pay a threshold of $50,000/quality-adjusted life-year. Universal urogynecologic consultation reduced the ultimate rate of FI from 25.33% to 22.67% and reduced patients living with untreated FI from 17.36% to 1.49%. Universal urogynecologic consultation increased the use of physical therapy by 14.14%, whereas rates of sacral neuromodulation and sphincteroplasty increased by only 2.48% and 0.58%, respectively. Universal urogynecologic consultation reduced the rate of vaginal delivery from 97.26% to 72.42%, which in turn led to a 1.15% increase in peripartum maternal complications.ConclusionsUniversal urogynecologic consultation in women with a history of OASIS is a cost-effective strategy that decreases the overall incidence of FI, increases treatment utilization for FI, and only marginally increases the risk of maternal morbidity.
类型	Article
语种	英语
收录类别	SCI-E
WOS记录号	WOS:000936938100007
WOS关键词	SACRAL NERVE-STIMULATION ; ELECTIVE CESAREAN DELIVERY ; 4TH-DEGREE PERINEAL TEARS ; SEVERE MATERNAL MORBIDITY ; VAGINAL DELIVERY ; URINARY-INCONTINENCE ; RISK ; IMPACT ; RECURRENCE ; MORTALITY
WOS类目	Obstetrics & Gynecology
WOS研究方向	Obstetrics & Gynecology
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/398959
推荐引用方式 GB/T 7714	Swallow, Christina H.,Harvey, Christina N.,Harmanli, Oz,et al. Universal Urogynecologic Consultation and Screening for Fecal Incontinence in Pregnant Women With a History of Obstetric Anal Sphincter Injury: A Cost-Effectiveness Analysis[J],2023,29(3):351-359.
APA	Swallow, Christina H.,Harvey, Christina N.,Harmanli, Oz,&Shepherd, Jonathan P..(2023).Universal Urogynecologic Consultation and Screening for Fecal Incontinence in Pregnant Women With a History of Obstetric Anal Sphincter Injury: A Cost-Effectiveness Analysis.UROGYNECOLOGY,29(3),351-359.
MLA	Swallow, Christina H.,et al."Universal Urogynecologic Consultation and Screening for Fecal Incontinence in Pregnant Women With a History of Obstetric Anal Sphincter Injury: A Cost-Effectiveness Analysis".UROGYNECOLOGY 29.3(2023):351-359.