title: Application of patient-reported outcome measures (PROMs) data to estimate cost-effectiveness of hernia surgery in England.
abstract: OBJECTIVE
  To demonstrate potential uses of nationally collected patient-reported outcome measures (PROMs) data to estimate cost-effectiveness of hernia surgery.
  
  
  METHODS
  Cost-utility model populated with national PROMs, National Reference Cost and Hospital Episodes Statistics data.
  
  
  METHODS
  Hospitals in England that provided elective inguinal hernia repair surgery for NHS patients between 1 April 2009 and 31 March 2010.
  
  
  METHODS
  Patients >18 years undergoing NHS-funded elective hernia surgery in English hospitals who completed PROMs questionnaires.
  
  
  METHODS
  Change in quality-adjusted life year (QALY) following surgery; cost per QALY of surgery by acute provider hospital; health gain and cost per QALY by surgery type received (laparoscopic or open hernia repair).
  
  
  RESULTS
  The casemix-adjusted, discounted (at 3.5%) and degraded (over 25 years) mean change in QALYs following elective hernia repair surgery is 0.826 (95% CI, 0.793-0.859) compared to a counterfactual of no treatment. Patients undergoing laparoscopic surgery show a significantly greater gain in health-related quality of life (EQ-5D index change, 0.0915; 95% CI, 0.0850-0.0979) with an estimated gain of 0.923 QALYS (95% CI, 0.859-0.988) compared to those having open repair (EQ-5D index change, 0.0806; 95% CI, 0.0771-0.0841) at 0.817 QALYS (95% CI, 0.782-0.852). The average cost of hernia surgery in England is £1554, representing a mean cost per QALY of £1881. The mean cost of laparoscopic and open hernia surgery is equivocal (£1421 vs. £1426 respectively) but laparoscopies appear to offer higher cost-utility at £1540 per QALY, compared to £1746 per QALY for open surgery.
  
  
  CONCLUSIONS
  Routine PROMs data derived from NHS patients could be usefully analyzed to estimate health outcomes and cost-effectiveness of interventions to inform decision-making. This analysis suggests elective hernia surgery offers value-for-money, and laparoscopic repair is more clinically effective and generates higher cost-utility than open surgery.
authors.affiliation: The King's Fund, London, UK. s.coronini-cronberg@imperial.ac.uk
authors.forename: Sophie
authors.initials: S
authors.lastname: Coronini-Cronberg
authors.forename: John
authors.initials: J
authors.lastname: Appleby
authors.forename: James
authors.initials: J
authors.lastname: Thompson
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D004469:Economics, Hospital; D004739:England; D017048:Health Care Costs; D006552:Hernia, Inguinal / Q000191:economics* / Q000601:surgery; D059685:Herniorrhaphy / Q000191:economics* / Q000379:methods; D006761:Hospitals; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D017063:Outcome Assessment, Health Care / Q000191:economics*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D057566:Self Report; D013222:State Medicine; D011795:Surveys and Questionnaires; D016896:Treatment Outcome