Open suture versus mesh repair of primary incisional hernias: a cost-utility analysis.

Hernia : the Journal of Hernias and Abdominal Wall Surgery
K R FinanM T Hawn

Abstract

Despite 100,000 ventral hernia repairs (VHR) being performed annually, no gold standard for the technique exists. Mesh has been shown to decrease recurrence rates, yet, concerns of increased complications and costs prevent its systematic use. We examined the cost-effectiveness of open suture (OS) versus open mesh (OM) in primary VHR. A decision analysis model from the payer's perspective comparing OS to OM was constructed for calculating the total costs and cost-effectiveness. Probabilities for complications and outcomes were derived from the literature. The costs represented institutional fixed costs. The outcome measure of effectiveness was recurrence. One-way sensitivity analysis and a probabilistic analysis using Monte Carlo simulation were performed. OS was associated with a total cost of $16,355 (+/-6,041) per repair, while OM was $16,947 (+/-7,252). At 3-year follow-up, OM was the more effective treatment with 73.8% being recurrence-free, compared with 56.3% in the OS group. The incremental cost to prevent one recurrence by the placement of mesh was $1,878. OM became the less effective treatment strategy when the infection rate exceeded 35%. At a willingness to pay level of $5,500, OM was the more cost-effective treatmen...Continue Reading

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Citations

Feb 9, 2013·Surgical Endoscopy·Karel W J KlopFrank J M F Dor
Jun 23, 2010·Hernia : the Journal of Hernias and Abdominal Wall Surgery·L VenclauskasM Kiudelis
Sep 12, 2012·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Drew ReynoldsJ Scott Roth
Jan 1, 2014·Plastic and Reconstructive Surgery·Abhishek ChatterjeeJoseph M Rosen
Jul 11, 2013·Hernia : the Journal of Hernias and Abdominal Wall Surgery·D MillbournL A Israelsson
Sep 17, 2013·The Surgical Clinics of North America·Curtis Bower, J Scott Roth
Mar 5, 2016·Hernia : the Journal of Hernias and Abdominal Wall Surgery·J-F GillionF Muysoms
Jan 27, 2015·Hernia : the Journal of Hernias and Abdominal Wall Surgery·F E MuysomsUNKNOWN European Hernia Society
Feb 11, 2010·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·H-J MischingerS Spendel
Dec 21, 2018·The Journal of Veterinary Medical Science·Madeh SadanSabry El-Khodery
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Sep 30, 2010·Journal of Investigative Surgery : the Official Journal of the Academy of Surgical Research·A H Petter-PuchnerH Redl
Apr 20, 2018·Frontiers in Surgery·Rhiannon L Harries, Jared Torkington
Jul 23, 2019·Advances in Surgery·Javier OteroB Todd Heniford

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