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

Published online by Cambridge University Press:  28 May 2004

Luke Vale ,
Adrian Grant ,
Kirsty McCormack ,
Neil W. Scott  and
Luke Vale
Affiliation:
University of Aberdeen
Adrian Grant
Affiliation:
University of Aberdeen
Kirsty McCormack
Affiliation:
University of Aberdeen
Neil W. Scott
Affiliation:
University of Aberdeen
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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.

Keywords

Cost-effectivenessSystematic reviewInguinal herniaSurgery
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 2 , April 2004 , pp. 192 - 200
Copyright
© 2004 Cambridge University Press

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