Tension-Free Repair Versus Watchful Waiting for Men with Asymptomatic or Minimally Symptomatic Inguinal Hernias: A Cost-Effectiveness Analysis

Kevin T. Stroupe, Larry M. Manheim, Ping Luo, Anita Giobbie-Hurder, Denise M. Hynes, Olga Jonasson, Domenic J. Reda, James O. Gibbs, Dorothy D. Dunlop, Robert Joseph Fitzgibbons

Research output: Contribution to journalArticle

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Abstract

Background: Watchful waiting (WW) has been shown to be an acceptable option in men with asymptomatic or minimally symptomatic inguinal hernias when clinical and patient-reported outcomes are considered. Although WW is likely to be less costly initially when compared with tension-free repair (TFR) because of the cost of the operation, it is not clear whether WW remains the least costly option when longer-term costs are considered. Study design: We conducted a cost-effectiveness analysis of a randomized controlled trial at six community and academic centers. We examined costs, quality-adjusted life-years (QALY), and cost-effectiveness at 2 years of followup. Costs were assessed by applying Medicare reimbursement rates to patients' health-care use, which was obtained by contacting patients' health-care providers. Quality of life was assessed using the Short Form-36 version 2 health-related quality-of-life survey. Of the 724 men randomized, 641 were available for the economic analysis: 317 were randomized to TFR and 324 were randomized to watchful waiting. Results: At 2 years, TFR patients had $1,831 higher mean costs than WW patients (95% CI, $409-$3,044), with 0.031 higher QALY (95% CI, 0.001-0.058). The cost per additional QALY for TFR patients was $59,065 (95% CI, $1,358-$322,765). The probability that TFR was cost-effective at the $50,000 per QALY level was 40%. Conclusion: At 2 years, WW was a cost-effective treatment option for men with minimal or no hernia symptoms.

Original languageEnglish
Pages (from-to)458-468
Number of pages11
JournalJournal of the American College of Surgeons
Volume203
Issue number4
DOIs
StatePublished - Oct 2006

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Watchful Waiting
Inguinal Hernia
Cost-Benefit Analysis
Quality-Adjusted Life Years
Costs and Cost Analysis
Patient Care
Quality of Life
Hernia
Medicare
Health Personnel
Health Care Costs
Randomized Controlled Trials
Economics
Delivery of Health Care

All Science Journal Classification (ASJC) codes

  • Surgery

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Tension-Free Repair Versus Watchful Waiting for Men with Asymptomatic or Minimally Symptomatic Inguinal Hernias : A Cost-Effectiveness Analysis. / Stroupe, Kevin T.; Manheim, Larry M.; Luo, Ping; Giobbie-Hurder, Anita; Hynes, Denise M.; Jonasson, Olga; Reda, Domenic J.; Gibbs, James O.; Dunlop, Dorothy D.; Fitzgibbons, Robert Joseph.

In: Journal of the American College of Surgeons, Vol. 203, No. 4, 10.2006, p. 458-468.

Research output: Contribution to journalArticle

Stroupe, Kevin T. ; Manheim, Larry M. ; Luo, Ping ; Giobbie-Hurder, Anita ; Hynes, Denise M. ; Jonasson, Olga ; Reda, Domenic J. ; Gibbs, James O. ; Dunlop, Dorothy D. ; Fitzgibbons, Robert Joseph. / Tension-Free Repair Versus Watchful Waiting for Men with Asymptomatic or Minimally Symptomatic Inguinal Hernias : A Cost-Effectiveness Analysis. In: Journal of the American College of Surgeons. 2006 ; Vol. 203, No. 4. pp. 458-468.
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abstract = "Background: Watchful waiting (WW) has been shown to be an acceptable option in men with asymptomatic or minimally symptomatic inguinal hernias when clinical and patient-reported outcomes are considered. Although WW is likely to be less costly initially when compared with tension-free repair (TFR) because of the cost of the operation, it is not clear whether WW remains the least costly option when longer-term costs are considered. Study design: We conducted a cost-effectiveness analysis of a randomized controlled trial at six community and academic centers. We examined costs, quality-adjusted life-years (QALY), and cost-effectiveness at 2 years of followup. Costs were assessed by applying Medicare reimbursement rates to patients' health-care use, which was obtained by contacting patients' health-care providers. Quality of life was assessed using the Short Form-36 version 2 health-related quality-of-life survey. Of the 724 men randomized, 641 were available for the economic analysis: 317 were randomized to TFR and 324 were randomized to watchful waiting. Results: At 2 years, TFR patients had $1,831 higher mean costs than WW patients (95{\%} CI, $409-$3,044), with 0.031 higher QALY (95{\%} CI, 0.001-0.058). The cost per additional QALY for TFR patients was $59,065 (95{\%} CI, $1,358-$322,765). The probability that TFR was cost-effective at the $50,000 per QALY level was 40{\%}. Conclusion: At 2 years, WW was a cost-effective treatment option for men with minimal or no hernia symptoms.",
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T1 - Tension-Free Repair Versus Watchful Waiting for Men with Asymptomatic or Minimally Symptomatic Inguinal Hernias

T2 - A Cost-Effectiveness Analysis

AU - Stroupe, Kevin T.

AU - Manheim, Larry M.

AU - Luo, Ping

AU - Giobbie-Hurder, Anita

AU - Hynes, Denise M.

AU - Jonasson, Olga

AU - Reda, Domenic J.

AU - Gibbs, James O.

AU - Dunlop, Dorothy D.

AU - Fitzgibbons, Robert Joseph

PY - 2006/10

Y1 - 2006/10

N2 - Background: Watchful waiting (WW) has been shown to be an acceptable option in men with asymptomatic or minimally symptomatic inguinal hernias when clinical and patient-reported outcomes are considered. Although WW is likely to be less costly initially when compared with tension-free repair (TFR) because of the cost of the operation, it is not clear whether WW remains the least costly option when longer-term costs are considered. Study design: We conducted a cost-effectiveness analysis of a randomized controlled trial at six community and academic centers. We examined costs, quality-adjusted life-years (QALY), and cost-effectiveness at 2 years of followup. Costs were assessed by applying Medicare reimbursement rates to patients' health-care use, which was obtained by contacting patients' health-care providers. Quality of life was assessed using the Short Form-36 version 2 health-related quality-of-life survey. Of the 724 men randomized, 641 were available for the economic analysis: 317 were randomized to TFR and 324 were randomized to watchful waiting. Results: At 2 years, TFR patients had $1,831 higher mean costs than WW patients (95% CI, $409-$3,044), with 0.031 higher QALY (95% CI, 0.001-0.058). The cost per additional QALY for TFR patients was $59,065 (95% CI, $1,358-$322,765). The probability that TFR was cost-effective at the $50,000 per QALY level was 40%. Conclusion: At 2 years, WW was a cost-effective treatment option for men with minimal or no hernia symptoms.

AB - Background: Watchful waiting (WW) has been shown to be an acceptable option in men with asymptomatic or minimally symptomatic inguinal hernias when clinical and patient-reported outcomes are considered. Although WW is likely to be less costly initially when compared with tension-free repair (TFR) because of the cost of the operation, it is not clear whether WW remains the least costly option when longer-term costs are considered. Study design: We conducted a cost-effectiveness analysis of a randomized controlled trial at six community and academic centers. We examined costs, quality-adjusted life-years (QALY), and cost-effectiveness at 2 years of followup. Costs were assessed by applying Medicare reimbursement rates to patients' health-care use, which was obtained by contacting patients' health-care providers. Quality of life was assessed using the Short Form-36 version 2 health-related quality-of-life survey. Of the 724 men randomized, 641 were available for the economic analysis: 317 were randomized to TFR and 324 were randomized to watchful waiting. Results: At 2 years, TFR patients had $1,831 higher mean costs than WW patients (95% CI, $409-$3,044), with 0.031 higher QALY (95% CI, 0.001-0.058). The cost per additional QALY for TFR patients was $59,065 (95% CI, $1,358-$322,765). The probability that TFR was cost-effective at the $50,000 per QALY level was 40%. Conclusion: At 2 years, WW was a cost-effective treatment option for men with minimal or no hernia symptoms.

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