Complex ventral hernia repair using components separation with or without synthetic mesh: a cost-utility analysis.

Area of Science:

• Surgical Innovation
• Health Economics
• Medical Device Technology

Background:

• Component separation is a key technique for complex ventral hernia repair.
• The use of synthetic mesh alongside component separation remains a subject of debate.
• This study addresses the cost-utility of synthetic mesh in these repairs.

Purpose of the Study:

• To conduct the first cost-utility analysis comparing component separation with and without synthetic mesh for complex ventral hernia repair.
• To evaluate the economic impact and patient outcomes of adding synthetic mesh.

Main Methods:

• A literature review identified complication and recurrence rates for component separation with/without synthetic mesh.
• A decision model integrated complication probabilities, Medicare reimbursement data, and utility estimates.
• Cost-effectiveness was evaluated for ventral hernia repairs (VHW I and II) in noncontaminated fields.

Main Results:

• Synthetic mesh increased costs by $541.69 and quality-adjusted life-years by 0.0357.
• The incremental cost-utility ratio was $15,173.39 per quality-adjusted life-year.
• Synthetic mesh remains cost-effective if its cost is below $2049.97.

Conclusions:

• The addition of synthetic mesh to component separation for complex ventral hernia repair is cost-effective at average retail prices.
• Synthetic mesh is recommended for use in patients with noncontaminated wounds undergoing these repairs.