Child/Adolescent Health

Dilators more cost-effective than surgery for correcting congenital condition in females

One in every 4,000 to 10,000 female infants is born with a congenital condition in which the vagina does not grow during embryologic development. Called vaginal agenesis, the condition can usually be corrected by surgery or by using dilators that are pushed daily against the area where the vagina should have formed to create a functional vagina. A new study finds that treating vaginal agenesis with dilators is much more cost-effective than surgery.

Using 2004 to 2009 cost data for 75 females from the Pediatric Health Information System database, researchers found that the cost of vaginoplasty, a surgery that creates a vagina using part of the woman's bowel, was $18,520. However, progressive perineal dilation (PPD) cost just $796. If PPD was unsuccessful and vaginoplasty was then pursued, the average per-patient cost rose to just $2,497. Further, using PPD alone yielded 60.2 quality-adjusted life years (QALYs) while vaginoplasty yielded just 55.7 QALYs.

Acknowledging that using dilators daily for 6 months to 2 years to create a vagina may be burdensome for young women, the authors found that using PPD first to correct vaginal agenesis was more cost-effective in 99.9 percent of all combinations of procedure costs, patient ages, and quality of life. This study was funded in part by the Agency for Healthcare Research and Quality (T32 HS00063).

See "Management strategies for Mayer-Rokitansky-Kuster-Hauser related vaginal agenesis: A cost-effectiveness analysis," by Jonathan C. Routh, M.D., Marc R. Laufer, M.D., Glenn M. Cannon, Jr., M.D., and others in the November 2010 The Journal of Urology 184(5), pp. 2116-2122.

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