title: TIPP and Lichtenstein modalities for inguinal hernia repair: a cost minimisation analysis alongside a randomised trial.
abstract: The transinguinal preperitoneal (TIPP) technique using a soft mesh with a memory ring was developed recently for inguinal hernia repair. To compare TIPP with the Lichtenstein method, a randomised trial was conducted (ISRCTN93798494). The aim of this study was to perform an economic evaluation of the TIPP modality compared to the Lichtenstein modality from both a hospital and societal perspective alongside the clinical trial. The TULIP study was a double-blind randomised clinical trial comparing two techniques for inguinal hernia repair (TIPP and Lichtenstein). Correct generation of the allocation sequence, allocation concealment, blinding, and follow-up were used/applied according to the recommendations of the Cochrane Handbook. Next to the cost drivers, the short-form-36 health survey (SF-36) data from the TULIP trial was used to determine utility. The SF-36 data from the TULIP trial were revised using the SF-6D algorithm according to Brazier. Two scenarios-a hospital and a societal perspective-were presented. If the analyses showed no difference in effects (on the SF-6D) the cost effectiveness decision rule to cost minimisation was altered. No significant difference in SF-6D utility between both modalities was found (mean difference: 0.888, 95% CI -1.02 to 1.23); consequently, the economic decision rule became cost minimisation. For the hospital perspective no significant differences in costs were found (mean difference: euro -13, 95% CI euro -130 to euro 104). However, when including productivity gains in the analysis, significant differences (P = 0.037) in costs favouring the TIPP modality (mean saving: euro 1,472, 95% CI euro 463- euro 2,714) were found. The results show that TIPP is a cost-saving inguinal hernia repair technique compared to the Lichtenstein modality against equal effectiveness expressed as quality adjusted life week at 1 year given a societal perspective. In the trial, TIPP patients showed on average a quicker recovery of 6.5 days compared to Lichtenstein patients.
authors.affiliation: Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, g.koning@chir.umcn.nl.
authors.forename: G G
authors.initials: GG
authors.lastname: Koning
authors.forename: E M M
authors.initials: EM
authors.lastname: Adang
authors.forename: P F M
authors.initials: PF
authors.lastname: Stalmeier
authors.forename: F
authors.initials: F
authors.lastname: Keus
authors.forename: P W H E
authors.initials: PW
authors.lastname: Vriens
authors.forename: C J H M
authors.initials: CJ
authors.lastname: van Laarhoven
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003365:Costs and Cost Analysis; D004311:Double-Blind Method; D005260:Female; D006306:Health Surveys; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged