title: Cost-utility analysis of the use of prophylactic mesh augmentation compared with primary fascial suture repair in patients at high risk for incisional hernia.
abstract: BACKGROUND
  Although hernia repair with mesh can be successful, prophylactic mesh augmentation (PMA) represents a potentially useful preventative technique to mitigate incisional hernia risk in select high-risk patients. The efficacy, cost-benefit, and societal value of such an intervention are not known. The aim of this study was to determine the cost-utility of using prophylactic mesh to augment fascial incisions.
  
  
  METHODS
  A decision tree model was employed to evaluate the cost-utility of using PMA relative to primary suture closure (PSC) after elective laparotomy. The authors adopted the societal perspective for cost and utility estimates. A systematic review of the literature on PMA was performed. The costs in this study included direct hospital costs and indirect costs to society, and utilities were obtained through a survey of 300 English-speaking members of the general public evaluating 14 health state scenarios relating to ventral hernia.
  
  
  RESULTS
  PSC without mesh demonstrated an expected average cost of $17,182 (average quality-adjusted life-year [QALY] of 21.17) compared with $15,450 (expected QALY was 21.21) for PMA. PSC was associated with an incremental cost-efficacy ratio (ICER) of -$42,444/QALY compared with PMA such that PMA was more effective and less costly. Monte Carlo sensitivity analysis was performed demonstrating more simulations resulting in ICERs for PSC above the willingness-to-pay threshold of $50,000/QALY, supporting the finding that PMA is superior.
  
  
  CONCLUSIONS
  Cost-utility analysis of PSC compared to PMA for abdominal laparotomy closure demonstrates PMA to be more effective, less costly, and overall more cost-effective than PSC.
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA. Electronic address: John.Fischer2@uphs.upenn.edu.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Marten N
authors.initials: MN
authors.lastname: Basta
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.affiliation: Department of Plastic Surgery, Georgetown University Hospital, Washington, DC.
authors.forename: Naveen M
authors.initials: NM
authors.lastname: Krishnan
authors.affiliation: Division of Plastic Surgery, Perelman School of Medicine at the Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
mesh_terms: D058107:Abdominal Wound Closure Techniques / Q000191:economics* / Q000295:instrumentation; D000328:Adult; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006555:Hernia, Ventral / Q000191:economics / Q000209:etiology / Q000517:prevention & control*; D017721:Hospital Costs; D006801:Humans; D007813:Laparotomy; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D013526:Surgical Mesh / Q000191:economics*; D013536:Suture Techniques / Q000191:economics*; D016896:Treatment Outcome; D014481:United States