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Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits

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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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Disclosures

Authors George Sgourakis, Georgia Dedemadi, Ines Gockel, Irene Schmidtmann, Sophocles Lanitis, Paraskevi Zaphiriadou, Athanasios Papatheodorou, and Constantine Karaliotas have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. 2nd Surgical Department and Surgical Oncology Unit of “Korgialenio-Benakio”, Red Cross Hospital, 11 Mantzarou St, Neo Psychiko, 15451, Athens, Greece

    George Sgourakis, Sophocles Lanitis, Paraskevi Zaphiriadou & Constantine Karaliotas

  2. Surgical Department, “A. Fleming” General Hospital, Athens, Greece

    Georgia Dedemadi

  3. Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany

    Ines Gockel

  4. Institute for Medical Biometry, Epidemiology und Informatics (IMBEI), Johannes Gutenberg University Hospital, Mainz, Germany

    Irene Schmidtmann

  5. Department of Radiology of “Korgialenio–Benakio”, Red Cross Hospital, Athens, Greece

    Athanasios Papatheodorou

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  1. George Sgourakis
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Sgourakis, G., Dedemadi, G., Gockel, I. et al. Laparoscopic totally extraperitoneal versus open preperitoneal mesh repair for inguinal hernia recurrence: a decision analysis based on net health benefits. Surg Endosc 27, 2526–2541 (2013). https://doi.org/10.1007/s00464-012-2776-4

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