Cost-effectiveness of alternative methods of surgical repair of inguinal hernia

Luke David Vale, Adrian Maxwell Grant, Kirsty McCormack, Neil William Scott, EU Hernia Trialists Collaboration

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Objectives: To assess the relative cost-effectiveness of laparoscopic methods of inguinal hernia repair compared with open flat mesh and open non-mesh repair.

Methods: Data on the effectiveness of these alternatives came from three systematic reviews comparing: (i) laparoscopic methods with open flat mesh or non-mesh methods; (ii) open flat mesh with open non-mesh repair; and (iii) methods that used synthetic mesh to repair the hernia defect with those that did not. Data on costs were obtained from the authors of economic evaluations previously conducted alongside trials included in the reviews. A Markov model was used to model cost-effectiveness for a five-year period after the initial operation. The outcomes of the model were presented using a balance sheet approach and as cost per hernia recurrence avoided and cost per extra day at usual activities.

Results: Open flat mesh was the most cost-effective method of preventing recurrences. Laparoscopic repair provided a shorter period of convalescence and less long-term pain compared with open flat mesh but was more costly. The mean incremental cost per additional day back at usual activities compared with open flat mesh was 38 and 80 for totally extraperitoneal and transabdominal preperitoneal repair, respectively.

Conclusions: Laparoscopic repair is not cost-effective compared with open flat mesh repair in terms of cost per recurrence avoided. Decisions about the use of laparoscopic repair depend on whether the benefits (reduced pain and earlier return to usual activities) outweigh the extra costs and intraoperative risks. On the evidence presented here, these extra costs are unlikely to be offset by the short-term benefits of laparoscopic repair.

Original languageEnglish
Pages (from-to)192-200
Number of pages8
JournalInternational Journal of Technology Assessment in Health Care
Volume20
Issue number2
DOIs
Publication statusPublished - Apr 2004

Keywords

  • cost-effectiveness
  • systematic review
  • inguinal hernia
  • surgery
  • RANDOMIZED PROSPECTIVE TRIAL
  • GROIN HERNIA
  • MESH REPAIR
  • HERNIORRHAPHY

Cite this

Cost-effectiveness of alternative methods of surgical repair of inguinal hernia. / Vale, Luke David; Grant, Adrian Maxwell; McCormack, Kirsty; Scott, Neil William; EU Hernia Trialists Collaboration.

In: International Journal of Technology Assessment in Health Care, Vol. 20, No. 2, 04.2004, p. 192-200.

Research output: Contribution to journalArticle

Vale, Luke David ; Grant, Adrian Maxwell ; McCormack, Kirsty ; Scott, Neil William ; EU Hernia Trialists Collaboration. / Cost-effectiveness of alternative methods of surgical repair of inguinal hernia. In: International Journal of Technology Assessment in Health Care. 2004 ; Vol. 20, No. 2. pp. 192-200.
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abstract = "Objectives: To assess the relative cost-effectiveness of laparoscopic methods of inguinal hernia repair compared with open flat mesh and open non-mesh repair.Methods: Data on the effectiveness of these alternatives came from three systematic reviews comparing: (i) laparoscopic methods with open flat mesh or non-mesh methods; (ii) open flat mesh with open non-mesh repair; and (iii) methods that used synthetic mesh to repair the hernia defect with those that did not. Data on costs were obtained from the authors of economic evaluations previously conducted alongside trials included in the reviews. A Markov model was used to model cost-effectiveness for a five-year period after the initial operation. The outcomes of the model were presented using a balance sheet approach and as cost per hernia recurrence avoided and cost per extra day at usual activities.Results: Open flat mesh was the most cost-effective method of preventing recurrences. Laparoscopic repair provided a shorter period of convalescence and less long-term pain compared with open flat mesh but was more costly. The mean incremental cost per additional day back at usual activities compared with open flat mesh was 38 and 80 for totally extraperitoneal and transabdominal preperitoneal repair, respectively.Conclusions: Laparoscopic repair is not cost-effective compared with open flat mesh repair in terms of cost per recurrence avoided. Decisions about the use of laparoscopic repair depend on whether the benefits (reduced pain and earlier return to usual activities) outweigh the extra costs and intraoperative risks. On the evidence presented here, these extra costs are unlikely to be offset by the short-term benefits of laparoscopic repair.",
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