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 21 November 2017

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News

Cost–utility analysis of treatment options for inguinal hernia

A laparoscopic approach for inguinal hernia repair can be a cost-effective treatment option, find researchers in the February issue of Surgical Endoscopy.

News image

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In this study, researchers from Boston, Massachusetts, assessed the cost-effectiveness of laparoscopic inguinal hernia repair.

The research team analyzed the NSAS, NHDS (National Center for Health Statistics), HCUP-NIS (Agency for Healthcare Research and Quality) databases, as well as 51 randomized controlled trials. Overall, the study group constituted of a total of 1,513,008 hernia repairs.

The team calculated the clinical, economic, and quality-of-life outcomes expected from the different treatment options, using a Markov Monte Carlo decision model.

Components that affect the cost-effectiveness ratio are the ambulatory facility cost and the recurrence rate.
Surgical Endoscopy

They also used 2 logistic regression models to predict the probability of hospital admission after an ambulatory procedure, and the probability of death after inguinal hernia repair.

The researchers modeled 4 treatment strategies:

  1. laparoscopic repair (LR)
  2. open mesh (OM)
  3. open non-mesh (ONM),
  4. and
  5. expectant management.

They expressed costs in US dollars, and effectiveness in quality-adjusted life years (QALYs).

The main outcome measures were the average and the incremental cost-effectiveness (ICER) ratios.

The research team found that, compared to the expectant management, the incremental cost per QALY gained was $605 for LR, $697 for OM, and $1711 for ONM.

In sensitivity analysis, the 2 major components that affect the cost-effectiveness ratio of the different types of repair, were the ambulatory facility cost, and the recurrence rate.

At a LR ambulatory facility cost of $5526 the ICER of LR, compared to OM surpasses the threshold of $50,000/QALY.

Dr Stylopoulos’s team concluded, “On the basis of our assumptions this mathematical model shows that from a societal perspective laparoscopic approach can be a cost-effective treatment option for inguinal hernia repair”.

Surg Endoscopy 2003; 17(2): 180-9
19 February 2003

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