Health economic analysis of total extraperitoneal repair versus Lichtenstein surgery for inguinal hernia: data from a randomized clinical trial.

L Westin,U Dahlstrand,U Gunnarsson,G Sandblom

doi:10.1093/bjsopen/zrab026

Abstract

BackgroundThe aim was to compare cost-effectiveness of Lichtenstein under local anaesthesia (LLA) with total extraperitoneal repair (TEP) under general anaesthesia for primary inguinal hernia in men. An endoscopic approach to inguinal hernia repair is often considered costlier. The cost of endoscopic hernia repair, however, has not been compared to open inguinal hernia repair in a cost-effective setting.MethodsData from an RCT comparing TEP and Lichtenstein in a cost-effective setting, with health economy as a secondary endpoint, were used. Data on costs were collected prospectively. Data on sick leave were obtained from the Swedish Social Insurance Agency in order to compare lengths of sick leave.ResultsIn total, 384 patients were included and 374 (97.4 per cent) patients were available for analysis, 189 in the LLA group and 185 in the TEP group. The median operating time for LLA was 70 (i.q.r. 60–80) min compared with 60 (i.q.r. 50–75) min in the TEP group (P < 0.001). The median time in operating theatre was 114 (i.q.r. 95–-125) min for LLA and 125 (i.q.r. 110–145) min for TEP (P < 0.001). The median cost including all materials was 2433 (i.q.r. 2084–2734) Euros for LLA and 2395 (i.q.r. 2093–2784) Euro for TEP (P = 0.650). Mean sick leave was 4.2 days in the LLA group and 6.2 days in the TEP group (P = 0.830).ConclusionThe overall cost to the hospital or length of sick leave did not differ between LLA and TEP.

Highlights

Inguinal hernia repair is one of the most common procedures in general surgery
In five cases the protocol was violated during administration of anaesthesia and these patients were excluded from the study prior to the surgical intervention, leaving 384 patients who underwent surgery according to the study allocation
Total costs for total extraperitoneal repair (TEP) and Lichtenstein did not differ in this RCT where each repair was performed in an optimal cost-effective setting

Summary

Introduction

In Sweden about 16 000 inguinal hernia repairs are performed each year[1]. Most of these patients are active and form part of the workforce. The main focus of improvement in inguinal hernia surgery has shifted from prevention of hernia recurrence to prevention of postoperative complications, in particular chronic pain. This shift has resulted in the evolution of alternative surgical techniques. The aim was to compare cost-effectiveness of Lichtenstein under local anaesthesia (LLA) with total extraperitoneal repair (TEP) under general anaesthesia for primary inguinal hernia in men.

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