title: Cost-effectiveness of groin hernia repair from a randomized clinical trial comparing commercial versus low-cost mesh in a low-income country.
abstract: BACKGROUND
  Over 200 million people worldwide live with groin hernia and 20 million are operated on each year. In resource-scarce settings, the superior surgical technique using a synthetic mesh is not affordable. A low-cost alternative is needed. The objective of this study was to calculate and compare costs and cost-effectiveness of inguinal hernia mesh repair using a low-cost versus a commercial mesh in a rural setting in Uganda.
  
  
  METHODS
  This is a cost-effectiveness analysis of a double-blinded RCT comparing outcomes from groin hernia mesh repair using a low-cost mesh and a commercially available mesh. Cost-effectiveness was expressed in US dollars (with euros in parentheses, exchange rate 30 December 2016) per disability-adjusted life-year (DALY) averted and quality-adjusted life-year (QALY) gained.
  
  
  RESULTS
  The cost difference resulting from the choice of mesh was $124·7 (€118·1). In the low-cost mesh group, the cost per DALY averted and QALY gained were $16·8 (€15·9) and $7·6 (€7·2) respectively. The corresponding costs were $58·2 (€55·1) and $33·3 (€31·5) in the commercial mesh group. A sensitivity analysis was undertaken including cost variations and different health outcome scenarios. The maximum costs per DALY averted and QALY gained were $148·4 (€140·5) and $84·7 (€80·2) respectively.
  
  
  CONCLUSIONS
  Repair using both meshes was highly cost-effective in the study setting. A potential cost reduction of over $120 (nearly €120) per operation with use of the low-cost mesh is important if the mesh technique is to be made available to the many millions of patients in countries with limited resources.
  
  
  BACKGROUND
  ISRCTN20596933 (http://www.controlled-trials.com).
authors.affiliation: Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Löfgren
authors.affiliation: Mubende Regional Referral Hospital, Makerere University, Kampala, Uganda.
authors.forename: A
authors.initials: A
authors.lastname: Matovu
authors.affiliation: Department of Surgery, St Göran's Hospital, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Wladis
authors.affiliation: School of Biomedical Sciences, Makerere University, Kampala, Uganda.
authors.forename: C
authors.initials: C
authors.lastname: Ibingira
authors.affiliation: Department of Surgery and Perioperative Sciences, Umeå University, Umeå, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Nordin
authors.affiliation: School of Public Health, Iganga/Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.
authors.forename: E
authors.initials: E
authors.lastname: Galiwango
authors.affiliation: Department of Public Health Sciences, The Karolinska Institute, Solna, Sweden.
authors.forename: B C
authors.initials: BC
authors.lastname: Forsberg
mesh_terms: D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures / Q000191:economics; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D003906:Developing Countries; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D006552:Hernia, Inguinal / Q000191:economics* / Q000601:surgery; D059685:Herniorrhaphy / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000191:economics; D008875:Middle Aged; D061646:Operative Time; D019057:Quality-Adjusted Life Years; D012423:Rural Health; D013526:Surgical Mesh / Q000191:economics*; D016896:Treatment Outcome; D014454:Uganda; D055815:Young Adult