Cost-effectiveness of alternative methods of surgical repair of inguinal hernia.
OBJECTIVE
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 Euro 38 and Euro 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.
Vale
Luke
L
Health Economics Research Unit, University of Aberdeen, Foresterhill, UK. l.vale@abdn.ac.uk
Grant
Adrian
A
McCormack
Kirsty
K
Scott
Neil W
NW
D002986:Clinical Trials as Topic; D003362:Cost-Benefit Analysis; D006119:Groin / Q000601:surgery; D006552:Hernia, Inguinal / Q000191:economics* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008390:Markov Chains; D013526:Surgical Mesh / Q000191:economics