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J Am Coll Surg. 2019 Jan;228(1):66-71. doi: 10.1016/j.jamcollsurg.2018.10.009. Epub 2018 Oct 22.

Cost-Utility Analysis of Biologic and Biosynthetic Mesh in Ventral Hernia Repair: When Are They Worth It?

Author information

1
Vanderbilt University School of Medicine, Vanderbilt University Medical Center Nashville, TN. Electronic address: steven.j.schneeberger@vanderbilt.edu.
2
Department of Biostatistics, Vanderbilt University Medical Center Nashville, TN.
3
Department of Surgery, Division of General Surgery, Vanderbilt University Medical Center Nashville, TN.
4
Vanderbilt University School of Medicine, Vanderbilt University Medical Center Nashville, TN.
5
Center for Abdominal Core Health, Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.

Abstract

BACKGROUND:

Biologic and biosynthetic meshes typically cost more than synthetic meshes for use in ventral hernia repair (VHR), with unknown comparative effectiveness.

STUDY DESIGN:

Cost-utility analysis was performed from a limited societal perspective assessing direct medical costs and outcomes for open, elective, retromuscular VHR. Short-term and 5-year major complications and costs were modeled using best available evidence from published studies, Healthcare Cost and Utilization Project data, and Americas Hernia Society Quality Collaborative data. Costs were analyzed in 2017 US dollars, and utilities were assessed using quality adjusted life years (QALYs). Sensitivity analyses were performed to determine threshold probabilities of long-term complications favoring particular mesh types.

RESULTS:

Synthetic mesh was the preferred strategy, with a cost of $15,620 and QALYs of 18.85, assuming a baseline 5.6% rate of long-term complications for all meshes. One-way sensitivity analysis demonstrated that biosynthetic and biologic mesh became the better choice as long-term complication rates for synthetic mesh increased to 15.5% and 26.2%, respectively. Two-way sensitivity analysis demonstrated that biologic and biosynthetic meshes became favorable as the cost of biologic mesh decreased and long-term synthetic mesh complication rates increased. Biologic and biosynthetic meshes also became more cost-effective when their relative long-term complication rates decreased and long-term synthetic mesh complication rates increased.

CONCLUSIONS:

Using modeling techniques, synthetic mesh is the best option for retromuscular VHR given currently available evidence. We established long-term complication thresholds, possibly justifying the higher up-front costs for biologic or biosynthetic meshes. This emphasizes the critical need to obtain long-term complication surveillance data to help individualize mesh choice in VHR.

[Indexed for MEDLINE]

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