title: Tension-free repair versus watchful waiting for men with asymptomatic or minimally symptomatic inguinal hernias: a cost-effectiveness analysis.
abstract: BACKGROUND
  Watchful waiting (WW) has been shown to be an acceptable option in men with asymptomatic or minimally symptomatic inguinal hernias when clinical and patient-reported outcomes are considered. Although WW is likely to be less costly initially when compared with tension-free repair (TFR) because of the cost of the operation, it is not clear whether WW remains the least costly option when longer-term costs are considered.
  
  
  METHODS
  We conducted a cost-effectiveness analysis of a randomized controlled trial at six community and academic centers. We examined costs, quality-adjusted life-years (QALY), and cost-effectiveness at 2 years of followup. Costs were assessed by applying Medicare reimbursement rates to patients' health-care use, which was obtained by contacting patients' health-care providers. Quality of life was assessed using the Short Form-36 version 2 health-related quality-of-life survey. Of the 724 men randomized, 641 were available for the economic analysis: 317 were randomized to TFR and 324 were randomized to watchful waiting.
  
  
  RESULTS
  At 2 years, TFR patients had $1,831 higher mean costs than WW patients (95% CI, $409-$3,044), with 0.031 higher QALY (95% CI, 0.001-0.058). The cost per additional QALY for TFR patients was $59,065 (95% CI, $1,358-$322,765). The probability that TFR was cost-effective at the $50,000 per QALY level was 40%.
  
  
  CONCLUSIONS
  At 2 years, WW was a cost-effective treatment option for men with minimal or no hernia symptoms.
authors.affiliation: Cooperative Studies Program Coordinating Center, Edward Hines Jr VA Hospital, 5th Avenue and Roosevelt Road, Hines, IL 60141, USA. kevin.stroupe@va.gov
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Stroupe
authors.forename: Larry M
authors.initials: LM
authors.lastname: Manheim
authors.forename: Ping
authors.initials: P
authors.lastname: Luo
authors.forename: Anita
authors.initials: A
authors.lastname: Giobbie-Hurder
authors.forename: Denise M
authors.initials: DM
authors.lastname: Hynes
authors.forename: Olga
authors.initials: O
authors.lastname: Jonasson
authors.forename: Domenic J
authors.initials: DJ
authors.lastname: Reda
authors.forename: James O
authors.initials: JO
authors.lastname: Gibbs
authors.forename: Dorothy D
authors.initials: DD
authors.lastname: Dunlop
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Fitzgibbons
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D017048:Health Care Costs; D006552:Hernia, Inguinal / Q000191:economics / Q000628:therapy*; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D013526:Surgical Mesh / Q000191:economics*; D016896:Treatment Outcome