Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits |
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Authors: | George Sgourakis Georgia Dedemadi Ines Gockel Irene Schmidtmann Sophocles Lanitis Paraskevi Zaphiriadou Athanasios Papatheodorou Constantine Karaliotas |
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Institution: | 1. 2nd Surgical Department and Surgical Oncology Unit of “Korgialenio-Benakio”, Red Cross Hospital, 11 Mantzarou St, Neo Psychiko, 15451, Athens, Greece 2. Surgical Department, “A. Fleming” General Hospital, Athens, Greece 3. Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany 4. Institute for Medical Biometry, Epidemiology und Informatics (IMBEI), Johannes Gutenberg University Hospital, Mainz, Germany 5. Department of Radiology of “Korgialenio–Benakio”, Red Cross Hospital, Athens, Greece
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Abstract: | Background The aim of this study is to evaluate the most cost-effective treatment strategy using preperitoneal mesh for patients with recurrent inguinal hernia. Currently, the issue of cost-effectiveness is entirely unresolved. Methods A decision analysis was carried out based on the results of a systematic literature review of articles concerning recurrent inguinal hernia repair that were published between 1979 and 2011. A virtual cohort was programmed to undergo three different treatment procedures: (1) laparoscopic totally extraperitoneal hernia repair (TEP), (2) open preperitoneal mesh repair according to Stoppa, and (3) open preperitoneal mesh repair according to Nyhus. We carried out a base-case analysis and varied all variables over a broad range of reasonable hypotheses in multiple one-way and two-way sensitivity analyses. Results The average cost-effectiveness ratio of Nyhus, Stoppa, and TEP per quality-adjusted life year was US $ ($)1,942, $1,948, and $2,011, respectively. In terms of the incremental cost-effectiveness ratio (ICER), Stoppa was dominated. The choice between TEP or Nyhus procedure depends on the combination of a specific center’s rates of recurrence and morbidity as disclosed by three-way sensitivity analysis. Conclusions Nyhus and TEP repairs are possible optimal choices depending primarily on the institution’s rates of recurrence and morbidity. Based on our net benefit-related decision analysis, a hypothetical “fixed budget trade-off” suggests potential annual incremental health system cost savings of $200,000 attained by shifting care for 1,000 patients from TEP to Nyhus repair (depending on clinical end-points, which is a decisive factor). |
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