title: Cost benefit analysis of mesh reinforcement of stapled left pancreatectomy.
abstract: OBJECTIVE
  Pancreatic leak is a morbid complication following left pancreatectomy, which results in prolonged hospitalization, additional diagnostic testing and invasive procedures. The present authors have previously demonstrated that mesh reinforcement of stapled left pancreatectomy results in fewer pancreatic leaks. This study was conducted to investigate whether mesh reinforcement also results in cost benefits for the health care system.
  
  
  METHODS
  A cost benefit model was developed to estimate net cost savings from the payer's perspective. The model is based on the results of a randomized, single-blinded trial of mesh versus no mesh reinforcement of the pancreatic remnant after left pancreatectomy. A two-way sensitivity analysis was conducted to determine the model's sensitivity to fluctuations in the cost of mesh and the effectiveness of the mesh in reducing clinically significant leaks.
  
  
  RESULTS
  Average total costs for an episode of care were US$13 337 and US$15 505 for patients who did and did not receive mesh, respectively, which indicates savings of US$2168. Two-way sensitivity analysis showed that, given a probability of 1.9% for developing a clinically significant leak in patients in whom mesh reinforcement was used, the strategy would continue to save costs if mesh were priced at ≤US$1804.
  
  
  CONCLUSIONS
  Mesh reinforcement decreases clinically significant pancreatic leaks. Despite the additional cost of mesh reinforcement, the use of mesh reinforcement results in overall cost savings for the health care system because of the resultant decrease in the occurrence of clinically significant leaks.
authors: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors: Kamran
authors: K
authors: Idrees
authors: Center for Economic Evaluation in Medicine, Washington University School of Medicine, St Louis, MO, USA.
authors: Joshua R
authors: JR
authors: Edler
authors: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.|Siteman Cancer Center, St Louis, MO, USA.
authors: David C
authors: DC
authors: Linehan
authors: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.|Siteman Cancer Center, St Louis, MO, USA.
authors: Steven M
authors: SM
authors: Strasberg
authors: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors: David
authors: D
authors: Jacques
authors: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors: Nicholas A
authors: NA
authors: Hamilton
authors: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.|Siteman Cancer Center, St Louis, MO, USA.
authors: Ryan C
authors: RC
authors: Fields
authors: Center for Economic Evaluation in Medicine, Washington University School of Medicine, St Louis, MO, USA.
authors: Dennis
authors: D
authors: Lambert
authors: Center for Economic Evaluation in Medicine, Washington University School of Medicine, St Louis, MO, USA.
authors: Steven
authors: S
authors: Kymes
authors: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.|Siteman Cancer Center, St Louis, MO, USA.|Department of Surgery, St Louis Veterans Affairs Medical Center, St Louis, MO, USA.
authors: William G
authors: WG
authors: Hawkins
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000191:economics / Q000601:surgery*; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D006801:Humans; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016037:Single-Blind Method; D013526:Surgical Mesh / Q000191:economics*; D017792:Surgical Stapling / Q000191:economics*; D013536:Suture Techniques / Q000191:economics* / Q000295:instrumentation; D014481:United States