title: Cost-conscious decisions in the timing of operation for minimally symptomatic inguinal hernias in male patients.
abstract: BACKGROUND
  Expectant management (EM) and early open repair (OR) are safe and effective as initial management strategies for minimally symptomatic inguinal hernia in male patients. Extended follow-up of patients in EM protocols have shown that most patients will eventually require repair, but it is not clear which strategy is less costly over the long term.
  
  
  METHODS
  We constructed a mathematical model to compare 3rd-party payer expenditures for EM vs OR or laparoscopic repair in a simulated cohort of patients with inguinal hernia. Cohort characteristics and expenditures were calibrated to recent randomized trials that reported initial follow-up and expenditures at 2 years and long-term crossover rates from EM to OR.
  
  
  RESULTS
  Cost comparisons between OR and EM are sensitive to direct long-term costs of inpatient and outpatient care, the likelihood of crossover from EM to operation, cost differences between OR and laparoscopic repair, and the net present value of longer-term costs.
  
  
  CONCLUSIONS
  Our findings suggest that short-term costs of EM are less than those of OR and Lap-R, but early OR provides the highest long-term savings.
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, H047, P.O. Box 850, Hershey, PA 17033-0850, USA.
authors.forename: Aliasgher
authors.initials: A
authors.lastname: Khaku
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, H047, P.O. Box 850, Hershey, PA 17033-0850, USA; Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.affiliation: Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, H047, P.O. Box 850, Hershey, PA 17033-0850, USA. Electronic address: dsoybel@hmc.psu.edu.
authors.forename: David I
authors.initials: DI
authors.lastname: Soybel
mesh_terms: D000368:Aged; D001071:Appointments and Schedules; D000066491:Clinical Decision-Making; D015331:Cohort Studies; D017046:Cost Savings; D017048:Health Care Costs; D006552:Hernia, Inguinal / Q000191:economics / Q000601:surgery*; D059685:Herniorrhaphy / Q000191:economics* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000191:economics / Q000379:methods; D007813:Laparotomy / Q000191:economics / Q000379:methods; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States
keywords: Expectant management; Inguinal hernia; Laparoscopic repair; Net present value; Observation; Open tension-free repair