Cost-Utility Analysis of Ventral Hernia Repair With a Bridging Biologic Mesh
Lin Lin Gao, MD, Marten N. Basta, MD, Liza Wu, MD, Stephen J. Kovach, III, MD, John Fischer, MD.
University of Pennsylvania Health System, Philadelphia, PA, USA.
The economic burden of ventral hernia repair with a bridging biologic mesh is substantial. The aim of this study is to examine the cost-utility of ventral hernia repair with a bridging biologic mesh.
We designed a decision tree model to compare ventral hernia repair with bridging biologic mesh versus no repair (Fig. 1). Health state probabilities were determined from literature review. Costs were obtained from National DRG reimbursements. To determine QALYs (quality-adjusted life years), a prospective survey was administered to 300 nationally representative individuals for 14 VHR-specific health states. We performed one-way univariate, two-way multivariate sensitivity analysis, threshold analysis and Monte Carlo simulations.
Ventral hernia repair with bridging biologic mesh compared to no repair is highly cost effective with Incremental Cost Effectiveness Ratio (ICER) of \.93/QALY. One-way sensitivity analysis showed repair with biologic mesh remained cost effective. Threshold analysis showed the rate of hernia recurrence need to reach 96% or the cost of hernia repair with bridging biologic mesh to be at least \,256 in order for repair not to be cost effective. Monte Carlo simulations showed greater than 98.6% of cases recommending repair with biologic mesh as a cost effective option.
Despite the high cost of biologic mesh, bridging biologic mesh ventral hernia repair is cost effective and these findings may facilitate clinical decision-making and support its continued use.
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