Cost effectiveness of laparoscopic versus open mesh hernia operation: results of a Department of Veterans Affairs randomized clinical trial.

摘要: BACKGROUND: Evidence comparing laparoscopic versus open hernia repair has varied with time and changes in techniques used. Cost effectiveness is an important consideration when evidence for predominance of one surgical technique lacking. Current cost estimates are not available. STUDY DESIGN: This study a analysis within randomized controlled trial (OPEN) (LAP) using mesh at 14 Department Veterans Affairs medical centers, 2-year followup each patient. Between January 1999 November 2001, 2,164 men inguinal were 1,983 had operation; 1,395 patients (708 OPEN 687 LAP) outpatient operations included the analysis. Outcomes postoperative costs, quality adjusted life years (QALY), incremental per QALY gained or ratio (ICER). RESULTS: Over 2 years, LAP average $638 more than OPEN. QALYs similar, resulting $45,899 (95% CI: -$669,045, $722,457). The probability that effective $50,000 level (slightly costly but effective), was 51%. For unilateral primary recurrent repair, probabilities 64% 81%, respectively. bilateral less effective. CONCLUSIONS: Overall, compared repair. (primary recurrent) hernia, treatment option.