Open suture versus mesh repair of primary incisional hernias: a cost-utility analysis.
BACKGROUND
Despite 100,000 ventral hernia repairs (VHR) being performed annually, no gold standard for the technique exists. Mesh has been shown to decrease recurrence rates, yet, concerns of increased complications and costs prevent its systematic use. We examined the cost-effectiveness of open suture (OS) versus open mesh (OM) in primary VHR.


METHODS
A decision analysis model from the payer's perspective comparing OS to OM was constructed for calculating the total costs and cost-effectiveness. Probabilities for complications and outcomes were derived from the literature. The costs represented institutional fixed costs. The outcome measure of effectiveness was recurrence. One-way sensitivity analysis and a probabilistic analysis using Monte Carlo simulation were performed.


RESULTS
OS was associated with a total cost of $16,355 (+/-6,041) per repair, while OM was $16,947 (+/-7,252). At 3-year follow-up, OM was the more effective treatment with 73.8% being recurrence-free, compared with 56.3% in the OS group. The incremental cost to prevent one recurrence by the placement of mesh was $1,878. OM became the less effective treatment strategy when the infection rate exceeded 35%. At a willingness to pay level of $5,500, OM was the more cost-effective treatment strategy.


CONCLUSIONS
In subjects without contraindication to mesh placement, OM repair is the more effective surgical treatment for VHR, with a lower risk of recurrence at a small cost to the payer.
Finan
K R
KR
Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, KB 417, 1530 3rd Ave S, Birmingham, AL 35294, USA.
Kilgore
M L
ML
Hawn
M T
MT
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D046449:Hernia, Abdominal / Q000191:economics* / Q000601:surgery*; D006801:Humans; D009010:Monte Carlo Method; D011183:Postoperative Complications / Q000453:epidemiology; D011336:Probability; D012008:Recurrence; D013526:Surgical Mesh / Q000191:economics*; D013536:Suture Techniques / Q000191:economics*