Tension-Free Repair Versus Watchful Waiting for Men with Asymptomatic or Minimally Symptomatic Inguinal Hernias: A Cost-Effectiveness Analysis - 09/08/11
†, ‡, §, ⁎ 
, Larry M. Manheim, PhD ‡, Ping Luo, PhD , Anita Giobbie-Hurder, MS , Denise M. Hynes, RN, PhD †, §, 
, Olga Jonasson, MD, FACS ¶, Domenic J. Reda, PhD , , James O. Gibbs, PhD ‡, Dorothy D. Dunlop, PhD ‡, Robert J. Fitzgibbons, MD, FACS †† Cooperative Studies Program Coordinating Center, Edward Hines Jr VA Hospital, Hines, IL Stritch School of Medicine, Loyola University Chicago, Maywood, IL School of Public Health, University of Illinois Chicago, Chicago, IL Correspondence address: Kevin T Stroupe, PhD, Midwest Center for Health Services and Policy Research, Edward Hines Jr VA Hospital, PO Box 5000 (151H), 5th Ave and Roosevelt Rd, Bldg 1B260, Hines, IL 60141-5151.Résumé |
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.
Le texte complet de cet article est disponible en PDF.Abbreviations and Acronyms : APC, CPT, ICER, QALY, SF-36, TFR, WW
Plan
| Competing Interests Declared: Robert J Fitzgibbons is retained as an expert in a class action suit for Davol, and he is a consultant for TyRx Pharma, Inc, a venture capital company trying to develop an antibiotic and local anesthetic-impregnated mesh for the TFR operation. These do not pertain directly to the subject of this article. Support for this project was funded by the Agency for Healthcare Research and Quality (R01 HS 09860) and the American College of Surgeons. The views expressed are solely those of the authors. |
Vol 203 - N° 4
P. 458-468 - octobre 2006 Retour au numéro
Article précédent
- 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 Fitzgibbons, Olga Jonasson, Leigh Neumayer, Veterans Affairs Cooperative Studies Program 456 Investigators
- Locoregional Recurrence after Mastectomy: Incidence and Outcomes
- Claire L. Buchanan, Paige L. Dorn, Jane Fey, Gladys Giron, Arpana Naik, Jane Mendez, Colleen Murphy, Lisa M. Sclafani
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