Complex ventral hernia repair using components separation with or without biologic mesh: a cost-utility analysis.
BACKGROUND
A complex ventral hernia requiring abdominal wall reconstruction presents a challenging scenario to the surgeon. The use of biologic mesh in addition to performing a components separation (CS) is controversial. Our goal was to perform the first cost-utility analysis on the use of biologic mesh in addition to performing CS when performing complex ventral hernia repair.


METHODS
A comprehensive literature review was conducted to identify published complication and recurrence rates for ventral hernia repairs requiring CS with or without biologic mesh. The probabilities of the most common complications were combined with Medicare Current Procedural Terminology reimbursement codes, diagnosis related group reimbursement codes, and expert utility estimates to fit into a decision model to evaluate the cost utility of CS with and without biologic mesh in reconstructing ventral hernias.


RESULTS
The decision model revealed a baseline cost increase of $775.65 and a 0.0517 increase in the quality-adjusted life-years when using biologic mesh yielding an incremental cost-utility ratio of $15,002.90/quality-adjusted life-year. One-way sensitivity analysis revealed that using biologic mesh was cost-effective using Medicare reimbursement rates but not at retail costs. The maximum price of biologic mesh to be cost-effective was $1813.53.


CONCLUSIONS
The cost utility of biologic mesh when used with CS in ventral hernia repair is dependent on the financial perspective. It is cost-ineffective for hospitals and physicians paying retail costs but cost-effective for third-party payers providing Medicare reimbursement.
From the *Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon; and †Geisel School of Medicine at Dartmouth, Hanover, NH.
Abhishek
A
Chatterjee
Naveen M
NM
Krishnan
Joseph M
JM
Rosen
D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006555:Hernia, Ventral / Q000191:economics / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D013526:Surgical Mesh / Q000191:economics*; D014481:United States