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.|
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:
- laparoscopic repair (LR)
- open mesh (OM)
- open non-mesh (ONM),
- 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”.