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

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Abstract

Background

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.

Methods

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.

Results

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 treatment strategy.

Conclusion

In subjects without contraindication to mesh placement, OM repair is the more effective surgical treatment for VHR, with a lower risk of recurrence at a small cost to the payer.

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Acknowledgments

We would like to thank Dr. Miguel Arguedas for his assistance in the decision modeling and Ms. Catherine Vick for her assistance in providing probabilities from the Veterans Affairs Medical Center ventral hernia repair study. K.R. Finan is a research fellow for the Department of Surgery supported by an educational grant funded by Olympus America Inc. This research was presented at the 2005 American College of Surgeons Clinical Congress, Surgical Forum in San Francisco, California, October 2005, and was awarded the Surgeons’ Forum on Fundamental Surgical Problems Resident/Fellow Excellence in Research Award.

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Authors and Affiliations

  1. Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, KB 417, 1530 3rd Ave S, Birmingham, AL, 35294, USA

    K. R. Finan & M. T. Hawn

  2. Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    M. L. Kilgore

  3. Deep South Center for Effectiveness Research, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA

    M. T. Hawn

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  1. K. R. Finan
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  3. M. T. Hawn
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Correspondence to M. T. Hawn.

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Finan, K.R., Kilgore, M.L. & Hawn, M.T. Open suture versus mesh repair of primary incisional hernias: a cost–utility analysis. Hernia 13, 173–182 (2009). https://doi.org/10.1007/s10029-008-0462-1

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  • DOI: https://doi.org/10.1007/s10029-008-0462-1

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