title: Complex ventral hernia repair using components separation with or without synthetic mesh: a cost-utility analysis.
abstract: BACKGROUND
  Components separation provides a useful option among closure choices for complex ventral hernia repairs. The use of synthetic mesh in addition to performing a components separation is controversial. The authors' goal was to perform the first cost-utility analysis on the use of synthetic mesh in addition to performing components separation when performing a complex ventral hernia repair in a noncontaminated field.
  
  
  METHODS
  A comprehensive literature review was conducted to identify published complication and recurrence rates for ventral hernia repairs (Ventral Hernia Workgroup I and II) requiring components separation with or without synthetic 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-effectiveness of components separation with and without synthetic mesh in reconstructing ventral hernias.
  
  
  RESULTS
  At average retail costs, the decision model revealed a cost increase of $541.69 and a 0.0357 increase in quality-adjusted life-years when using synthetic mesh, yielding a cost-effective incremental cost-utility ratio of $15,173.39 per quality-adjusted life-year. Univariate sensitivity analysis revealed that synthetic mesh is cost-effective when it costs less than $2049.97.
  
  
  CONCLUSIONS
  The addition of synthetic mesh when performing components separation in repairing complex ventral hernias is cost-effective when using average retail prices. Physicians and hospitals should use synthetic mesh in patients with noncontaminated wounds.
authors.affiliation: Lebanon, N.H. From the Dartmouth Hitchcock Medical Center.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Chatterjee
authors.forename: Naveen M
authors.initials: NM
authors.lastname: Krishnan
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Rosen
mesh_terms: D003362:Cost-Benefit Analysis; D006555:Hernia, Ventral / Q000191:economics* / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control; D055502:Secondary Prevention; D013526:Surgical Mesh / Q000191:economics* / Q000706:statistics & numerical data*