eP378 - A Cost-Utility Study of Elective Rectal Prolapse Repairs in Canada

Purpose/Background: Surgery remains an effective treatment for rectal prolapse, with consistent evidence for improvements in quality-of-life. Valuing the benefits of rectal prolapse repairs on patients' postoperative well-being is important for evaluating the effectiveness of healthcare resources. We aimed to measure the gains in health utility of rectal prolapse surgery versus the surgery’s costs through measures of cost-utility. Cost utility measures were calculated by applying preference-based measures of health and Canada-specific health utility measures and costs.Methods/Interventions: Patients undergoing elective rectal prolapse repairs from general and colorectal surgeons in British Columbia between September 2013 and November 2021 were recruited to complete the EuroQol quality-of-life questionnaires (EQ-5D-5L) preoperatively and postoperatively. Quality-adjusted life years (QALYs) attributable to surgery were calculated by comparing discounted health utility values derived from the EQ-5D-5L. Costs incorporated hospital overhead and specialists’ fees. The analysis accounted for different recurrence rates for both the abdominal-approach (10%, 15%, and 20%) and the perineal-approach (15%, 20%, 30%).Results/Outcomes: Of 46 participants that completed both surveys, the mean gain in QALYs 10 years after surgery was 1.1681 assuming recurrence rates of 15% and 20% for abdominal and perineal-approach repairs, respectively. The average cost of the surgery was $7,325. The average cost per quality-adjusted life years was $7,958 when health benefits were assumed to accrue for 10 years following surgery, adjusted for recurrences. The cost per quality-adjusted life year was higher for male sex ($8,611/QALY male vs. $7,382/QALY female), age greater than 65 ($9,944/QALY >65 years vs. $6,708/QALY 65 years of under), and perineal-approach repairs ($8,572/QALY perineal vs. $6,061/QALY).Conclusion/

Discussion: Surgical repair of rectal prolapses resulted in gains in health status and were inexpensive relative to its resultant gains in quality-of-life based on established willingness-to-pay benchmarks of $50,000USD/QALY for interventions.

*Please note the data used in this study is generated from a prospectively maintained cohort of patients undergoing rectal prolapse repairs. We expect that by the time of presentation, the number of participants will increase and data will be updated as such.Figure 1.Jitter plot demonstrating the increase in health utility from before to after an elective rectal prolapse repair.