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Cost-Utility Analysis Comparing Heavy-Weight and Light-Weight Mesh in Laparoscopic Surgery for Unilateral Inguinal Hernias

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Abstract

Background

Hernioplasty is one of the most frequent surgeries in the UK. Light-weight mesh (LWM) has the potential to reduce chronic groin pain but its cost-effectiveness compared with heavy-weight mesh (HWM) is unknown.

Objective

Our objective was to conduct a cost-utility analysis between laparoscopic hernioplasty with HWM and LWM for unilateral inguinal hernias.

Methods

A Markov model simulated costs and health outcomes over a period of 1 year (2012) from the societal and National Health Service (NHS) perspective (England). The main outcome was cost per quality-adjusted life-year (QALY) gained. Surgery results were gleaned from the randomized control trial by Bittner et al. Other input parameters were drawn from the literature and public sources of the NHS.

Results

From the societal perspective, LWM induces lower incremental costs (−£88.85) than HWM but yields a slightly smaller incremental effect (−0.00094 QALYs). The deterministic incremental cost-effectiveness ratio (ICER) for HWM compared with LWM amounts to £94,899 per QALY, while the probabilistic ICER is £118,750 (95 % confidence interval [CI] £57,603–180,920). Owing to the withdrawal of productivity losses from the NHS perspective, LWM causes higher incremental costs (£13.09) and an inferior incremental effect (−0.00093), resulting in a dominance of HWM over LWM (ICER 95 % CI −£12,382 to −£21,590).

Conclusions

There is no support for the adoption of LWM as standard treatment from an NHS perspective. However, given the small differences between HWM and LWM, LWM has at least the potential of improving patient outcomes and reducing expenditure from the societal perspective.

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Author contributions

DA contributed to the conception and design of the study, as well as to synthesis, interpretation of the data, statistical analysis, and drafting of the manuscript. TS contributed to the statistical analysis, interpretation of the results and critical revision of the manuscript. DA takes responsibility for the integrity of the data and the accuracy of the data analysis.

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This study has not received any funding.

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The authors declare they have no conflicts of interest.

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  1. Hamburg Center for Health Economics (HCHE), University of Hamburg, Esplanade 36, 20354, Hamburg, Germany

    Dmitrij Achelrod & Tom Stargardt

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Achelrod, D., Stargardt, T. Cost-Utility Analysis Comparing Heavy-Weight and Light-Weight Mesh in Laparoscopic Surgery for Unilateral Inguinal Hernias. Appl Health Econ Health Policy 12, 151–163 (2014). https://doi.org/10.1007/s40258-014-0082-0

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