Cost Effectiveness of Laparoscopic Versus Open Mesh Hernia Operation

Results of a Department of Veterans Affairs Randomized Clinical Trial

Denise M. Hynes, Kevin T. Stroupe, Ping Luo, Anita Giobbie-Hurder, Domenic Reda, Margaret Kraft, Kamal Itani, Robert Joseph Fitzgibbons, Olga Jonasson, Leigh Neumayer

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background: Evidence comparing laparoscopic versus open hernia repair has varied with time and with changes in techniques used. Cost effectiveness is an important consideration when evidence for predominance of one surgical technique is lacking. Current cost estimates of hernia repair are not available. Study design: This study is a cost effectiveness analysis within a randomized controlled trial comparing open (OPEN) versus laparoscopic (LAP) hernia repair using mesh at 14 Department of Veterans Affairs medical centers, with 2-year followup for each patient. Between January 1999 and November 2001, 2,164 men with inguinal hernia were randomized and 1,983 had an operation; 1,395 patients (708 OPEN and 687 LAP) with outpatient hernia operations were included in the cost effectiveness analysis. Outcomes included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). Results: Over 2 years, LAP cost an average of $638 more than OPEN. QALYs at 2 years were similar, resulting in $45,899 per QALY gained (95% CI: -$669,045, $722,457). The probability that LAP is cost effective at the $50,000 per QALY level (slightly more costly but more effective), was 51%. For unilateral primary and unilateral recurrent hernia repair, the probabilities that LAP is cost effective at the $50,000 per QALY level were 64% and 81%, respectively. For bilateral hernia repair, OPEN was less costly and more effective. Conclusions: Overall, laparoscopic hernia repair is not cost effective compared with open repair. For patients with unilateral (primary or recurrent) hernia, laparoscopic repair is a cost effective treatment option.

Original languageEnglish
Pages (from-to)447-457
Number of pages11
JournalJournal of the American College of Surgeons
Volume203
Issue number4
DOIs
StatePublished - Oct 2006

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Herniorrhaphy
Veterans
Hernia
Quality-Adjusted Life Years
Cost-Benefit Analysis
Randomized Controlled Trials
Costs and Cost Analysis
Inguinal Hernia
Health Care Costs
Outpatients

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Cost Effectiveness of Laparoscopic Versus Open Mesh Hernia Operation : Results of a Department of Veterans Affairs Randomized Clinical Trial. / Hynes, Denise M.; Stroupe, Kevin T.; Luo, Ping; Giobbie-Hurder, Anita; Reda, Domenic; Kraft, Margaret; Itani, Kamal; Fitzgibbons, Robert Joseph; Jonasson, Olga; Neumayer, Leigh.

In: Journal of the American College of Surgeons, Vol. 203, No. 4, 10.2006, p. 447-457.

Research output: Contribution to journalArticle

Hynes, Denise M. ; Stroupe, Kevin T. ; Luo, Ping ; Giobbie-Hurder, Anita ; Reda, Domenic ; Kraft, Margaret ; Itani, Kamal ; Fitzgibbons, Robert Joseph ; Jonasson, Olga ; Neumayer, Leigh. / Cost Effectiveness of Laparoscopic Versus Open Mesh Hernia Operation : Results of a Department of Veterans Affairs Randomized Clinical Trial. In: Journal of the American College of Surgeons. 2006 ; Vol. 203, No. 4. pp. 447-457.
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abstract = "Background: Evidence comparing laparoscopic versus open hernia repair has varied with time and with changes in techniques used. Cost effectiveness is an important consideration when evidence for predominance of one surgical technique is lacking. Current cost estimates of hernia repair are not available. Study design: This study is a cost effectiveness analysis within a randomized controlled trial comparing open (OPEN) versus laparoscopic (LAP) hernia repair using mesh at 14 Department of Veterans Affairs medical centers, with 2-year followup for each patient. Between January 1999 and November 2001, 2,164 men with inguinal hernia were randomized and 1,983 had an operation; 1,395 patients (708 OPEN and 687 LAP) with outpatient hernia operations were included in the cost effectiveness analysis. Outcomes included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). Results: Over 2 years, LAP cost an average of $638 more than OPEN. QALYs at 2 years were similar, resulting in $45,899 per QALY gained (95{\%} CI: -$669,045, $722,457). The probability that LAP is cost effective at the $50,000 per QALY level (slightly more costly but more effective), was 51{\%}. For unilateral primary and unilateral recurrent hernia repair, the probabilities that LAP is cost effective at the $50,000 per QALY level were 64{\%} and 81{\%}, respectively. For bilateral hernia repair, OPEN was less costly and more effective. Conclusions: Overall, laparoscopic hernia repair is not cost effective compared with open repair. For patients with unilateral (primary or recurrent) hernia, laparoscopic repair is a cost effective treatment option.",
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T1 - Cost Effectiveness of Laparoscopic Versus Open Mesh Hernia Operation

T2 - Results of a Department of Veterans Affairs Randomized Clinical Trial

AU - Hynes, Denise M.

AU - Stroupe, Kevin T.

AU - Luo, Ping

AU - Giobbie-Hurder, Anita

AU - Reda, Domenic

AU - Kraft, Margaret

AU - Itani, Kamal

AU - Fitzgibbons, Robert Joseph

AU - Jonasson, Olga

AU - Neumayer, Leigh

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N2 - Background: Evidence comparing laparoscopic versus open hernia repair has varied with time and with changes in techniques used. Cost effectiveness is an important consideration when evidence for predominance of one surgical technique is lacking. Current cost estimates of hernia repair are not available. Study design: This study is a cost effectiveness analysis within a randomized controlled trial comparing open (OPEN) versus laparoscopic (LAP) hernia repair using mesh at 14 Department of Veterans Affairs medical centers, with 2-year followup for each patient. Between January 1999 and November 2001, 2,164 men with inguinal hernia were randomized and 1,983 had an operation; 1,395 patients (708 OPEN and 687 LAP) with outpatient hernia operations were included in the cost effectiveness analysis. Outcomes included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). Results: Over 2 years, LAP cost an average of $638 more than OPEN. QALYs at 2 years were similar, resulting in $45,899 per QALY gained (95% CI: -$669,045, $722,457). The probability that LAP is cost effective at the $50,000 per QALY level (slightly more costly but more effective), was 51%. For unilateral primary and unilateral recurrent hernia repair, the probabilities that LAP is cost effective at the $50,000 per QALY level were 64% and 81%, respectively. For bilateral hernia repair, OPEN was less costly and more effective. Conclusions: Overall, laparoscopic hernia repair is not cost effective compared with open repair. For patients with unilateral (primary or recurrent) hernia, laparoscopic repair is a cost effective treatment option.

AB - Background: Evidence comparing laparoscopic versus open hernia repair has varied with time and with changes in techniques used. Cost effectiveness is an important consideration when evidence for predominance of one surgical technique is lacking. Current cost estimates of hernia repair are not available. Study design: This study is a cost effectiveness analysis within a randomized controlled trial comparing open (OPEN) versus laparoscopic (LAP) hernia repair using mesh at 14 Department of Veterans Affairs medical centers, with 2-year followup for each patient. Between January 1999 and November 2001, 2,164 men with inguinal hernia were randomized and 1,983 had an operation; 1,395 patients (708 OPEN and 687 LAP) with outpatient hernia operations were included in the cost effectiveness analysis. Outcomes included surgical and postoperative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). Results: Over 2 years, LAP cost an average of $638 more than OPEN. QALYs at 2 years were similar, resulting in $45,899 per QALY gained (95% CI: -$669,045, $722,457). The probability that LAP is cost effective at the $50,000 per QALY level (slightly more costly but more effective), was 51%. For unilateral primary and unilateral recurrent hernia repair, the probabilities that LAP is cost effective at the $50,000 per QALY level were 64% and 81%, respectively. For bilateral hernia repair, OPEN was less costly and more effective. Conclusions: Overall, laparoscopic hernia repair is not cost effective compared with open repair. For patients with unilateral (primary or recurrent) hernia, laparoscopic repair is a cost effective treatment option.

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