A cost-effectiveness analysis of tension-free versus shouldice inguinal hernia repair: a randomized double-blind clinical trial.
BACKGROUND
The use of open tension-free techniques in hernia surgery seems to be superior to those techniques that apply tension to the suture line. However, the cost-effectiveness of tension vs. tension-free repairs has not been investigated before.


METHODS
This study is a cost-effectiveness analysis within a randomized controlled clinical trial that compared open-tension (OT) versus mesh-plug tension-free (MPTF) hernia repair, with a 2-year follow-up for each patient. Between July 2002 and June 2003, 106 patients with inguinal hernia were randomized to either procedure. Main outcome measures included average surgical time, time to full recovery, pain visual analog scale, amount of analgesics required, off-work time, hospital stay, and heath-care costs.


RESULTS
The average cost was $885.15 (95% CI $843.56-$926.74) and $837.66 (95% CI $796.42-878.89) USD for the OT and the MPTF herniorrhaphy, respectively (P < 0.05). Average yearly savings with the MPTF repair were calculated as $7,598.84 USD. Surgery time, time to full recovery, pain visual-analog scale, use of analgesics, off-work time, and hospital stay were significantly lower for the MPTF repair. Disability-adjusted life-years were reduced 56% with the MPTF repair, which represented a total savings of $12,656.60 USD with this procedure.


CONCLUSIONS
This controlled clinical trial demonstrates that the MPTF technique significantly decreases care costs in patients operated on for inguinal hernias.
Prieto-Díaz-Chávez
E
E
Department of Surgery, General Hospital No 1, Mexican Institute of Social Security in Colima, Colima, Mexico. epdch@hotmail.com
Medina-Chávez
J L
JL
Anaya-Prado
R
R
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013526:Surgical Mesh; D013514:Surgical Procedures, Operative / Q000191:economics* / Q000379:methods*