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Prophylactic Mesh Placement With Ileal Conduit: A Cost-effectiveness Analysis.
Diboro L Kanabolo1, Sangtae Park2
1Department of Urology, University of Washington Medical Center, Seattle, WA.
Urology
|April 29, 2023
Summary
Prophylactic mesh placement during ileal conduit urinary diversion for bladder cancer is cost-effective. It improves quality of life and prevents parastomal hernias (PSH) across all cancer stages.
Area of Science:
- Urology
- Surgical Oncology
- Health Economics
Background:
- Parastomal hernias (PSH) affect over 50% of stoma patients.
- Mesh prophylaxis reduces PSH in end-colostomy and ileal conduits.
- Cost-effectiveness of mesh for ileal conduits in bladder cancer is unstudied.
Purpose of the Study:
- To evaluate the cost-effectiveness of mesh prophylaxis in ileal conduit urinary diversion for bladder cancer.
- To assess the impact of mesh placement on quality of life and PSH prevention.
Main Methods:
- A Markov model was developed to analyze costs and quality-adjusted life years (QALY).
- Data were sourced from literature and adjusted to 2022 US dollars.
- Sensitivity analyses were conducted to validate model robustness.
Main Results:
- Mesh placement incurred an average incremental cost of $897.
- Mesh provided an average incremental effectiveness of 0.49 QALY.
- The incremental cost-effectiveness ratio was $2114.71/QALY.
- Mesh benefit was sensitive to infection probability.
Conclusions:
- Prophylactic mesh placement is a cost-effective strategy for preventing PSH in bladder cancer patients.
- Mesh improves quality of life across all stages of bladder cancer.
- Mesh prophylaxis is recommended during radical cystectomy with ileal conduit formation.
