title: A Cost-Utility Assessment of Mesh Selection in Clean-Contaminated Ventral Hernia Repair.
abstract: BACKGROUND
  Mesh reinforcement can reduce hernia recurrence, but mesh selection is poorly understood, particularly in contaminated defects. Acellular dermal matrix has enabled single-stage ventral hernia repair in clean-contaminated wounds but can be associated with higher complications and cost compared with synthetic mesh. This study evaluated the cost-utility of synthetic mesh and acellular dermal matrix for clean-contaminated ventral hernia repairs.
  
  
  METHODS
  A systematic review of articles comparing outcomes for synthetic and acellular dermal matrix repairs identified 14 ventral hernia repair-specific health states. Quality-adjusted life years were determined through Web-based visual analog scale survey of 300 nationally representative individuals. Overall expected cost and quality-adjusted life-years for ventral hernia repair were assessed using a Monte Carlo simulation with sensitivity analyses.
  
  
  RESULTS
  Synthetic mesh reinforcement had an expected cost of $15,776 and quality-adjusted life-year value gained of 21.03. Biological mesh had an expected cost of $23,844 and quality-adjusted life-year value gained of 20.94. When referencing a common baseline (do nothing), acellular dermal matrix (incremental cost-effectiveness ratio, 3378 ($/quality-adjusted life years)) and synthetic mesh (incremental cost-effectiveness ratio, 2208 ($/quality-adjusted life years)) were judged cost-effective, although synthetic mesh was more strongly favored. Monte Carlo sensitivity analysis demonstrated that synthetic mesh was the preferred and most cost-effective strategy in 94 percent of simulations, supporting its overall greater cost-utility. Despite varying the willingness-to-pay threshold from $0 to $100,000 per quality-adjusted life-year, synthetic mesh remained the optimal strategy across all thresholds in sensitivity analysis.
  
  
  CONCLUSIONS
  This cost-utility analysis suggests that synthetic mesh repair of clean-contaminated hernia defects is more cost-effective than acellular dermal matrix.
authors.affiliation: Philadelphia, Pa.; and Washington, D.C. From the Division of Plastic Surgery, Perelman School of Medicine at the University of Pennsylvania, University of Pennsylvania Health System; and the Department of Plastic Surgery, Georgetown University Hospital.
authors.forename: John P
authors.initials: JP
authors.lastname: Fischer
authors.forename: Marten N
authors.initials: MN
authors.lastname: Basta
authors.forename: Naveen M
authors.initials: NM
authors.lastname: Krishnan
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wink
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kovach
mesh_terms: D062088:Acellular Dermis; D001424:Bacterial Infections / Q000150:complications / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D006555:Hernia, Ventral / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics* / Q000295:instrumentation*; D006801:Humans; D013526:Surgical Mesh / Q000191:economics*
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