Evaluation of Societal Health State Utility of Pelvic Organ Prolapse

INTRODUCTION: Despite an increasing prevalence of pelvic organ prolapse and an aging population in the United States, there is a paucity of data surrounding the cost-effectiveness of treatment. An accurate measure of the health state utility is needed to perform such economic evaluations. OBJECTIVE: The objective of this study was to obtain a health state utility measure for different stages of pelvic organ prolapse from a societal perspective and to calculate this measure among a population of healthy volunteers. METHODS: Health state descriptions for this study were developed based on literature review, using language and figures consistent with widely available patient-centered resources. They include a standardized symptom description along with representative figures and photographs of the condition. They were finalized after an expert panel review completed in conjunction with a series of exploratory and pilot interviews. Adult volunteers without a diagnosis of pelvic organ prolapse were enrolled through a primary gynecology clinic. They were assigned to one of three stages (II, III, or IV) of pelvic organ prolapse. After reviewing the health state description in the presence of a trained interviewer, volunteers completed the standard gamble interview (SG) and EuroQoL 5-Dimension 5-Level Instrument (EQ-5D) to arrive at the utility of each health state. Differences between utility values were then calculated for each stage of prolapse, and between the three techniques with standard gamble as the referent. RESULTS: The study was conducted from September 2024 to April 2025. A total of 126 interviews were conducted. One hundred and seventeen individuals (n=117) were included in the final analysis. For each stage of pelvic organ prolapse, 39 individuals were interviewed after reviewing the clinical vignette. The median [IQR] age of this study population was 50.5 [34.0 to 60.0] years. When using the standard gamble interview, differences in the health state utility values obtained at each stage of pelvic organ prolapse were not statistically significant (stage II, 0.82 [0.68 to 0.97]; stage III, 0.82 [0.65 to 0.93]; stage IV, 0.80 [0.60 to 0.90]; P=0.098) (Table 1). When compared to standard gamble approach, the health state utility measures obtained using EQ-5D and Visual Analogue Scale (VAS) were significantly lower at each stage of POP (EQ-5D: stage II, –0.18 [–0.25 to 0.02] (P<0.001); stage III, –0.39 [–0.79 to –0.02] (P<0.001); stage IV, –0.33 [–0.70 to –0.08] (P<0.001); VAS: stage II, –0.05 [–0.22 to 0.05] (P=0.034); stage III, –0.2 [–0.30 to 0.00] (P<0.001); stage IV, –0.2 [–0.40 to –0.10] (P=0.006)) (Table 2). CONCLUSIONS: This is the first study performed to evaluate the health state utility of pelvic organ prolapse from a societal perspective using healthy volunteers. Direct instruments for measuring health state utility, like the standard gamble, are often seen as the reference standard for use in cost-effectiveness analyses. In this study, the utility values obtained using generic instruments (EQ-5D and VAS) were significantly lower when compared to the standard gamble approach for all stages of pelvic organ prolapse. Thus, when conducting future cost-effective analyses, the values obtained using the standard gamble approach should be used.Table 1Table 2