Non-surgical interventions for pelvic organ prolapse in women: a component network meta-analysis and cost-effectiveness analysis

Research question: What are the most effective and cost-effective non-surgical interventions for treating pelvic organ prolapse in women?

Background: Pelvic organ prolapse (POP) is the descent of the female pelvic organs into the vagina. The condition is common, with a UK-based survey finding that 8.4% of women reported a vaginal bulge or lump. The prevalence of POP increases with age and so, given our ageing population, will be an increasing issue for women and the NHS.

Current National Institute for Health and Care Excellence (NICE) guidelines for POP recommend non-surgical treatments, e.g. pelvic floor muscle training (PFMT) and pessaries, as first-line treatment. There is currently limited evidence comparing how effective these non-surgical interventions for POP are nor is these enough evidence on their value for money for the NHS.

Uncertainty remains surrounding the effectiveness and cost-effectiveness of these interventions, which this work addresses. Aims and objectives: This work will answer 3 research questions: • What are the most effective non-surgical interventions for managing POP in women? • What are women’s preferences for these interventions?

• Which of these interventions is the most cost-effective from an NHS perspective?

Methods: We will conduct a component network meta-analysis (CNMA) of clinical effectiveness according to a pre-defined protocol. A CNMA is the most appropriate and robust method for synthesising data surrounding the potentially heterogenous and complex non-surgical interventions used to treat POP and will provide the best available evidence for decision making.

To explore women’s preferences for different ways care can be provided and its outcomes we will conduct a discrete choice experiment. The results of this and the CNMA will be incorporated into an economic evaluation model to assess cost-effectiveness.

The project will be governed and the conduct further influenced by patient co-applicants and an advisory group of up to 10 women with a lived experience of POP. They will build on the patient involvement embedded into this application to further refine and establish the methods for the CNMA and the health economics.

Timeline for delivery: We will deliver this work over 14 months. The CNMA will be conducted between months 1 and 10, with the DCE running between months 4 and 11. The structure of the economic model and additional model requirements will be identified between months 4 and 9, with the integration of the CNMA into the final model occurring in months 11 and 12.

The public advisory group will convene in month 1 and formally meet 4 times across the course of the project, as well as meeting to formally discuss and feed into methods across the course of the work.

Anticipated impact and dissemination: Our outputs include a detailed final report, at least two peer-reviewed academic journal articles, and conference presentations at relevant societal and methods-focused meetings. We will also feed the results of the project into guidelines produced by NICE, the European Association of Urology and the International Consultation on Incontinence to ensure our work directly impacts on clinical practice.

Our work with women with POP has already identified wider platforms to publicly share our work (e.g. radio and podcasts). We will continue to work with our PPIE co-applicants and advisory group to identify public-facing dissemination options and to co-produce dissemination materials.