title: Cost-utility analysis of repair of reducible ventral hernia.
abstract: BACKGROUND
  Patient-reported outcomes are an important metric of the effectiveness of care. Ventral hernia repair is a procedure where the effectiveness can best be quantified using health-related quality of life. This study sought to quantify quality of life with respect to costs of ventral hernia repair.
  
  
  METHODS
  This observational study of patients diagnosed with a ventral hernia between 2004-2011 in a single center identified 3 groups of patients: (1) Patients diagnosed with ventral hernias managed with observation, (2) patients diagnosed with ventral hernias who underwent operative repair only when incarceration occurred, and (3) patients with ventral hernias who underwent herniorraphy before incarceration. The Short Form (SF)12v2 was administered to measure quality of life. The direct costs of care were obtained from Financial Services. Patients were surveyed about direct, non-health costs to obtain a societal perspective. A cost-utility analysis was performed.
  
  
  RESULTS
  The SF-12v2 was administered to 243 patients; 80 were observed, 69 underwent repair of an incarcerated hernia, and 94 underwent repair of a nonincarcerated hernia. The response rates were similar among groups-59%, 55%, and 52%. Quality of life as measured by utility score was less at 0.68 (95% CI, 0.65-0.71) in patients who did not undergo repair compared with those after repair of a nonincarcerated hernia, 0.76 (95% CI, 0.73-0.79; P < .001). The elective repair of a nonincarcerated hernia was cost-effective with an incremental cost effectiveness ratio of $8,646 per quality-adjusted life-year.
  
  
  CONCLUSIONS
  The prompt elective repair of ventral hernias is cost-effective.
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Stey
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
authors.forename: Matthew
authors.initials: M
authors.lastname: Danzig
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Qiu
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
authors.forename: Sujing
authors.initials: S
authors.lastname: Yin
authors.affiliation: Department of Surgery, Icahn School of Medicine at Mount Sinai Hospital, New York, NY. Electronic address: celia.divino@mountsinai.org.
authors.forename: Celia M
authors.initials: CM
authors.lastname: Divino
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D017558:Elective Surgical Procedures / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006555:Hernia, Ventral / Q000191:economics / Q000601:surgery* / Q000628:therapy; D059685:Herniorrhaphy / Q000191:economics*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D057566:Self Report; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D057832:Watchful Waiting