Optimal treatment policies for pelvic organ prolapse in women

Abstract

Pelvic organ prolapse (POP) is a very common gynecological disorder greatly affecting the quality of life (QoL) of females in the society. Studies have shown that approximately 40% of women in the United States have POP that requires medical intervention. In clinical practice, there are four treatment options for POP: watchful waiting, conservative treatment, reconstructive surgery, and obliterative surgery. In this study, we utilize practical data obtained through surveys and clinical literature and develop a model to help physicians and POP patients dynamically select treatment options in order to maximize a patient's expected future QoL. Results from the model are presented in the form of optimal policy tables, which can be used by physicians and patients by entering several attributes as inputs, such as the patient's age, current observed QoL defined by the severity of POP symptoms, preferences over preserving coital function, and other potential restrictive conditions. The results show significant socioeconomic incentives for potential utilization of optimal treatment policies in POP treatment. We estimate based on QoL to dollar conversions that the expected value of improved QoL for an individual POP patient is around $10,000. When aggregated over the entire POP population seeking treatment, the total annual expected value for the society is at least $675 million under medium-level valuations of QoL. Although the optimization-based policies imply an overall increase of about $200 million in annual POP treatment costs, the net positive gains can make this trade-off an acceptable one.