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TIPP and Lichtenstein modalities for inguinal hernia repair: a cost minimisation analysis alongside a randomised trial

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Abstract

The transinguinal preperitoneal (TIPP) technique using a soft mesh with a memory ring was developed recently for inguinal hernia repair. To compare TIPP with the Lichtenstein method, a randomised trial was conducted (ISRCTN93798494). The aim of this study was to perform an economic evaluation of the TIPP modality compared to the Lichtenstein modality from both a hospital and societal perspective alongside the clinical trial. The TULIP study was a double-blind randomised clinical trial comparing two techniques for inguinal hernia repair (TIPP and Lichtenstein). Correct generation of the allocation sequence, allocation concealment, blinding, and follow-up were used/applied according to the recommendations of the Cochrane Handbook. Next to the cost drivers, the short-form-36 health survey (SF-36) data from the TULIP trial was used to determine utility. The SF-36 data from the TULIP trial were revised using the SF-6D algorithm according to Brazier. Two scenarios—a hospital and a societal perspective—were presented. If the analyses showed no difference in effects (on the SF-6D) the cost effectiveness decision rule to cost minimisation was altered. No significant difference in SF-6D utility between both modalities was found (mean difference: 0.888, 95 % CI −1.02 to 1.23); consequently, the economic decision rule became cost minimisation. For the hospital perspective no significant differences in costs were found (mean difference: €−13, 95 % CI €−130 to €104). However, when including productivity gains in the analysis, significant differences (P = 0.037) in costs favouring the TIPP modality (mean saving: €1,472, 95 % CI €463–€2,714) were found. The results show that TIPP is a cost-saving inguinal hernia repair technique compared to the Lichtenstein modality against equal effectiveness expressed as quality adjusted life week at 1 year given a societal perspective. In the trial, TIPP patients showed on average a quicker recovery of 6.5 days compared to Lichtenstein patients.

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Acknowledgements

The authors would like to thank the following people for participating, facilitating and/or contributing to the TULIP trial: R. van Doorn, M.S. Ibelings, G.P. Gerritsen, J. Heisterkamp, H.J.M. Oostvogel, M.H.J. Verhofstad, J.A. Roukema, J.P. de Schipper, J. van Breda, M. Avci, C.L. Cheung, E. Wolters - van Loon, A. Gillis, T. Hendriks, R. Opsteeg, L. Wesdijk, L. Koeslag. Many thanks also to the surgical residents, OPD- and ward nurses, and secretaries of the St. Elisabeth Hospital Tilburg and TweeSteden Hospital Tilburg and Waalwijk, The Netherlands. The authors also would like to thank W. Lemmens, R. Donders, and Professor G.J. van der Wilt (Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen, The Netherlands) for statistical calculations and their support.

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Authors and Affiliations

  1. Department of Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

    G. G. Koning, F. Keus & C. J. H. M. van Laarhoven

  2. Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands

    G. G. Koning & P. W. H. E. Vriens

  3. Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Nijmegen, Nijmegen, The Netherlands

    E. M. M. Adang & P. F. M. Stalmeier

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  1. G. G. Koning
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  2. E. M. M. Adang
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  3. P. F. M. Stalmeier
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  4. F. Keus
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  5. P. W. H. E. Vriens
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  6. C. J. H. M. van Laarhoven
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Correspondence to G. G. Koning.

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Trial registration: www.controlled-trials.com (ISRCTN93798494).

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Koning, G.G., Adang, E.M.M., Stalmeier, P.F.M. et al. TIPP and Lichtenstein modalities for inguinal hernia repair: a cost minimisation analysis alongside a randomised trial. Eur J Health Econ 14, 1027–1034 (2013). https://doi.org/10.1007/s10198-012-0453-0

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  • DOI: https://doi.org/10.1007/s10198-012-0453-0

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