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Application of a New Mesh Fixation Method in Laparoscopic Incisional Hernia Repair
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Complex ventral hernia repair using components separation with or without biologic mesh: a cost-utility analysis.

Abhishek Chatterjee1, Naveen M Krishnan, Joseph M Rosen

  • 1From the *Division of Plastic Surgery, Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon; and †Geisel School of Medicine at Dartmouth, Hanover, NH.

Annals of Plastic Surgery
|September 21, 2013
PubMed
Summary

The use of biologic mesh with components separation (CS) in complex ventral hernia repair is cost-effective for Medicare payers but not for those at retail cost. This analysis provides crucial financial insights for surgical decisions.

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Area of Science:

  • Abdominal Wall Reconstruction
  • Surgical Innovation
  • Health Economics

Background:

  • Complex ventral hernias pose significant surgical challenges.
  • The role of biologic mesh combined with components separation (CS) in repair is debated.
  • This study is the first cost-utility analysis of biologic mesh with CS for complex ventral hernia repair.

Purpose of the Study:

  • To evaluate the cost-utility of using biologic mesh alongside components separation (CS) in complex ventral hernia repair.
  • To compare the financial implications from different reimbursement perspectives.

Main Methods:

  • Conducted a literature review to gather complication and recurrence rates for CS with or without biologic mesh.
  • Developed a decision model incorporating complication probabilities, reimbursement data (Medicare, DRG), and utility estimates.
  • Evaluated the cost-utility of CS with and without biologic mesh.

Main Results:

  • Biologic mesh with CS increased costs by $775.65 and quality-adjusted life-years by 0.0517.
  • The incremental cost-utility ratio was $15,002.90/quality-adjusted life-year.
  • Cost-effectiveness was observed with Medicare reimbursement rates, but not at retail costs; the maximum cost-effective price for biologic mesh was $1813.53.

Conclusions:

  • The cost-utility of biologic mesh with CS in ventral hernia repair is perspective-dependent.
  • It is cost-ineffective for hospitals/physicians at retail cost.
  • It is cost-effective for third-party payers under Medicare reimbursement.