A Cost-utility Assessment of Mesh Selection in Clean-Contaminated Ventral Hernia Repair (VHR)
John P. Fischer, MD1, Marten N. Basta, B.S.1, Naveen M. Krishnan, MD, MPhil2, Jason D. Wink, MD, MTR1, Joseph M. Serletti, MD1, Stephen J. Kovach, III, MD1.
1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA, 22Department of Plastic Surgery, Georgetown University Hospital, Washington DC, DC, USA.
PURPOSE: Acellular dermal matrix (ADM) has provided a tool to perform single-stage ventral hernia repair (VHR) in clean-contaminated wounds, but can be associated with higher complications and cost compared to synthetic mesh. This study aimed to determine the cost-utility of synthetic mesh and ADM for clean-contaminated VHRs.
METHODS: A systematic review identified articles comparing outcomes for synthetic and ADM repairs. A web-based visual analog scale survey was administered to 300 nationally representative individuals to determine quality-adjusted life years (QALYs) for 14 VHR-specific health states. Overall expected cost and QALYs for VHR were assessed using a Monte-Carlo Simulation with sensitivity analyses.
RESULTS: Synthetic mesh reinforcement had an expected cost of $15,776 and QALY gained of 21.03, and ADM reinforcement had an expected cost of $23,844 and QALY gained of 20.94. When referencing a common baseline (Do Nothing), ADM (ICER=3,378) and synthetic mesh (ICER=2,208) were judged cost-effective, although synthetic mesh was more strongly favored. Monte-Carlo sensitivity analysis was performed varying all parameters simultaneously; overall, synthetic mesh was the preferred and most cost-efficient strategy in 94% of simulations, supporting synthetic mesh having greater cost-utility. Willingness-to-pay (WTP) threshold was varied from 0 to $100,000/QALY and synthetic mesh reinforcement remained the optimal strategy across all WTP thresholds.
CONCLUSION: This cost-utility analysis suggests that synthetic mesh repair of clean-contaminated hernia defects is less expensive and more effective than ADM.
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