Cost-effectiveness of inguinal herniorrhaphy at a tertiary care hospital

Abstract

Background : To determine the cost-effectiveness of elective inguinal herniorrhaphy for various repair methods, and to compare between them in the context of reoperation. Methods : Retrospective review of medical records from patients who underwent elective inguinal herniorrhaphy during the period between January 1998 and June 2014. The incremental cost-effective ratios (ICER) of hernia repairs were calculated by using the primary tissue repair as reference cost. Results : There were 1,415 patients with 1,787 elective inguinal hernia repairs. Of the 1,787 repairs, 91.9% (1,643) were for primary and 8% (144) were for secondary hernias. Tissue repairs were performed in 64.9% (1,159) of all operations, open mesh repairs in 22.3% (399) and laparoscopic mesh repair in 16.7% (229). There were 137 reoperations (7.7% of 1,787), 125 (7.6% of 1,643) for primary repairs and 12 (8.3% of 144) for secondary repairs. Differences in the reoperation rates were greatest for the first 3 years of an operation, after which all the rates tended to converge. According to the Cox regression model, risk factors significantly associated with higher reoperation rates included direct hernias, longer duration of operation, and older age. The average cost of reoperation for tissue repair, open mesh repair, and laparoscopic repair were 10,500 (350 US$), 17,307.00 (576.90 US$), 21,631.00 (721.03 US$) bath, respectively. The incremental cost-effective ratios of primary OM and LAP were 134.11 and 181.12, respectively. The incremental cost-effective ratios of secondary OM and LAP were 91.99 and 139.14, respectively. Conclusions : Open mesh repair seem to be more cost-effective than laparoscopic hernia repair.