title: Cost effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing permanent colostomy for rectal cancer.
abstract: BACKGROUND
  Parastomal hernia (PSH) is common after stoma formation. Studies have reported that mesh prophylaxis reduces PSH, but there are no cost-effectiveness data. Our objective was to determine the cost effectiveness of mesh prophylaxis vs no prophylaxis to prevent PSH in patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer.
  
  
  METHODS
  Using a cohort Markov model, we modeled the costs and effectiveness of mesh prophylaxis vs no prophylaxis at the index operation in a cohort of 60-year-old patients undergoing abdominoperineal resection for rectal cancer during a time horizon of 5 years. Costs were expressed in 2012 Canadian dollars (CAD$) and effectiveness in quality-adjusted life years. Deterministic and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  In patients with stage I to III rectal cancer, prophylactic mesh was dominant (less costly and more effective) compared with no mesh. In patients with stage IV disease, mesh prophylaxis was associated with higher cost (CAD$495 more) and minimally increased effectiveness (0.05 additional quality-adjusted life years), resulting in an incremental cost-effectiveness ratio of CAD$10,818 per quality-adjusted life year. On sensitivity analyses, the decision was sensitive to the probability of mesh infection and the cost of the mesh, and method of diagnosing PSH.
  
  
  CONCLUSIONS
  In patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer, mesh prophylaxis might be the less costly and more effective strategy compared with no mesh to prevent PSH in patients with stage I to III disease, and might be cost effective in patients with stage IV disease.
authors.affiliation: Steinberg-Bernstein Centre for Minimally-Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lee
authors.affiliation: Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Abdulaziz
authors.initials: A
authors.lastname: Saleem
authors.affiliation: Montreal General Hospital Library, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Tara
authors.initials: T
authors.lastname: Landry
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Latimer
authors.affiliation: Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Prosanto
authors.initials: P
authors.lastname: Chaudhury
authors.affiliation: Steinberg-Bernstein Centre for Minimally-Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: liane.feldman@mcgill.ca.
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
mesh_terms: D002170:Canada; D003125:Colostomy / Q000191:economics / Q000295:instrumentation* / Q000379:methods; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006555:Hernia, Ventral / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D018803:Models, Economic; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D013526:Surgical Mesh / Q000191:economics*; D054047:Surgical Stomas
keywords: CAD$; Canadian dollars; PSH; QALY; WTP; parastomal hernia; quality-adjusted life years; willing to pay