A cost--utility analysis of treatment options for inguinal hernia in 1,513,008 adult patients.
BACKGROUND
The controversial issue of the cost-effectiveness of laparoscopic inguinal hernia repair is examined, employing a decision analytic method.


METHODS
The NSAS, NHDS (National Center for Health Statistics), HCUP-NIS (Agency for Healthcare Research and Quality) databases and 51 randomized controlled trials were analyzed. The study group constituted of a total of 1,513,008 hernia repairs. Projection of the clinical, economic, and quality-of-life outcomes expected from the different treatment options was done by using a Markov Monte Carlo decision model. Two logistic regression models were used to predict the probability of hospital admission after an ambulatory procedure and the probability of death after inguinal hernia repair. Four treatment strategies were modeled: (1) laparoscopic repair (LR), (2) open mesh (OM), (3) open non-mesh (ONM), and (4) expectant management. Costs were expressed in US dollars and effectiveness in quality-adjusted life years (QALYs). The main outcome measures were the average and the incremental cost-effectiveness (ICER) ratios.


RESULTS
Compared to the expectant management, the incremental cost per QALY gained was 605 dollars (4086 dollars, 9.04 QALYs) for LR, 697 dollars (4290 dollars, 8.975 QALYs) for OM, and 1711 dollars (6200 dollars, 8.546 QALYs) for ONM. In sensitivity analysis the two major components that affect the cost-effectiveness ratio of the different types of repair were the ambulatory facility cost and the recurrence rate. At a LR ambulatory facility cost of 5526 dollars the ICER of LR compared to OM surpasses the threshold of 50,000 dollars/QALY.


CONCLUSIONS
On the basis of our assumptions this mathematical model shows that from a societal perspective laparoscopic approach can be a cost-effective treatment option for inguinal hernia repair.
Stylopoulos
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N
Massachusetts General Hospital, Boston, MA, USA.
Gazelle
G S
GS
Rattner
D W
DW
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D013505:Digestive System Surgical Procedures / Q000191:economics* / Q000401:mortality; D005260:Female; D006552:Hernia, Inguinal / Q000191:economics / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D010535:Laparoscopy / Q000191:economics* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009010:Monte Carlo Method; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012008:Recurrence; D018570:Risk Assessment; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome