Prophylactic Mesh Placement With Ileal Conduit: A Cost-effectiveness Analysis

To determine the cost-effectiveness of mesh placement in patients undergoing ileal conduit urinary diversion for bladder cancer. Long-term studies have shown that parastomal hernias (PSH) occur in more than half of all stomas. Mesh prophylaxis has been shown to reduce PSH after end-colostomy and ileal conduits. However, no cost-effectiveness studies on mesh prophylaxis have been performed for this population.

We created a Markov model incorporating the costs and effectiveness of mesh prophylaxis for patients undergoing radical cystectomy and ileal conduit construction. Costs were obtained from the literature and adjusted to 2022 US dollars. Effectiveness was measured in quality-adjusted life years (QALY). 1- and 2-way sensitivity analyses were performed to test the robustness of our model.

In stage I-IV bladder cancer, prophylactic mesh placement was costlier, but more effective in providing quality of life compared with no mesh placement at index surgery. Average incremental cost between the 2 strategies across all stages was an additional $897 when mesh was utilized. Incremental effectiveness averaged 0.49 additional QALY across all stages. This resulted in an incremental cost-effectiveness ratio of $2114.71/QALY. Sensitivity analyses indicated that benefit of mesh placement was sensitive to the probability of mesh infection.

In patients undergoing ileal conduit urinary diversion for bladder cancer, mesh prophylaxis at the time of radical cystectomy is an overall cost-effective strategy in preventing PSH for patients presenting with all stages of bladder cancer.