Cost Effectiveness of the Use of Prophylactic Mesh To Prevent Parastomal Hernia After Urinary Diversion with an Ileal Conduit.
Bladder cancer
Cost-effectiveness analysis
Cystectomy
Economic evaluation
Ileal conduit
Mesh
Parastomal hernia
Journal
European urology open science
ISSN: 2666-1683
Titre abrégé: Eur Urol Open Sci
Pays: Netherlands
ID NLM: 101771568
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
accepted:
25
03
2022
entrez:
31
5
2022
pubmed:
1
6
2022
medline:
1
6
2022
Statut:
epublish
Résumé
Prophylactic lightweight mesh in the sublay position reduced the cumulative incidence of parastomal hernia (PSH) after cystectomy with ileal conduit diversion in a randomised controlled trial. To investigate whether the use of prophylactic mesh is cost-effective in comparison to no mesh from the health care provider perspective. Data on health care resource utilisation (outpatient care and inpatient care) were obtained for 159 patients included in a randomised trial. The patients underwent surgery at Skåne University Hospital or Helsingborg County Hospital (80 with a prophylactic mesh and 79 without) and information about care was ascertained from the regional health care register. The patients underwent surgery between 2012 and 2017 and were followed until death or August 2020. The primary outcome measure was the clinical incidence of PSH. Costs are reported in Euro in 2020 prices (€1 = 10.486 Swedish Krona) and presented as the incremental cost-effectiveness ratios (ICERs) with confidence intervals (CIs) calculated using a nonparametric bootstrap procedure. Sensitivity analyses and subgroup analyses were performed to capture the uncertainty for ICERs. The mean difference in total costs between the mesh and no-mesh groups was -€2047 (95% CI -€16 441 to €12 348). Seventeen patients (21.5%) in the no-mesh group developed clinical PSH versus six patients (7.5%) in the mesh group ( The use of prophylactic mesh during ileal conduit reconstruction to prevent PSH is cost-effective from the health care provider perspective. In patients having their bladder surgically removed, a mesh implant can be inserted when a portion of the intestine is used to create an opening to drain urine from the body. Our results show that mesh use to prevent development of a hernia at the opening where urine exits the body is cost-effective from the perspective of health care providers.
Sections du résumé
Background
UNASSIGNED
Prophylactic lightweight mesh in the sublay position reduced the cumulative incidence of parastomal hernia (PSH) after cystectomy with ileal conduit diversion in a randomised controlled trial.
Objective
UNASSIGNED
To investigate whether the use of prophylactic mesh is cost-effective in comparison to no mesh from the health care provider perspective.
Design setting and participants
UNASSIGNED
Data on health care resource utilisation (outpatient care and inpatient care) were obtained for 159 patients included in a randomised trial. The patients underwent surgery at Skåne University Hospital or Helsingborg County Hospital (80 with a prophylactic mesh and 79 without) and information about care was ascertained from the regional health care register. The patients underwent surgery between 2012 and 2017 and were followed until death or August 2020.
Outcome measurements and statistical analyses
UNASSIGNED
The primary outcome measure was the clinical incidence of PSH. Costs are reported in Euro in 2020 prices (€1 = 10.486 Swedish Krona) and presented as the incremental cost-effectiveness ratios (ICERs) with confidence intervals (CIs) calculated using a nonparametric bootstrap procedure. Sensitivity analyses and subgroup analyses were performed to capture the uncertainty for ICERs.
Results and limitations
UNASSIGNED
The mean difference in total costs between the mesh and no-mesh groups was -€2047 (95% CI -€16 441 to €12 348). Seventeen patients (21.5%) in the no-mesh group developed clinical PSH versus six patients (7.5%) in the mesh group (
Conclusions
UNASSIGNED
The use of prophylactic mesh during ileal conduit reconstruction to prevent PSH is cost-effective from the health care provider perspective.
Patient summary
UNASSIGNED
In patients having their bladder surgically removed, a mesh implant can be inserted when a portion of the intestine is used to create an opening to drain urine from the body. Our results show that mesh use to prevent development of a hernia at the opening where urine exits the body is cost-effective from the perspective of health care providers.
Identifiants
pubmed: 35638084
doi: 10.1016/j.euros.2022.03.011
pii: S2666-1683(22)00064-7
pmc: PMC9142740
doi:
Types de publication
Journal Article
Langues
eng
Pagination
9-15Informations de copyright
© 2022 The Author(s).
Références
Colorectal Dis. 2021 Nov;23(11):2967-2979
pubmed: 34331840
J Am Coll Surg. 2014 Jan;218(1):82-91
pubmed: 24210147
Dig Surg. 2014;31(4-5):366-76
pubmed: 25531238
BMJ. 2013 Jun 07;346:f3197
pubmed: 23747967
Monaldi Arch Chest Dis. 2012 Sep;78(3):155-9
pubmed: 23614330
Scand J Urol. 2020 Dec;54(6):501-507
pubmed: 33063578
BMJ. 2013 Mar 25;346:f1049
pubmed: 23529982
Br J Surg. 2017 Feb;104(3):179-186
pubmed: 28004850
Expert Rev Pharmacoecon Outcomes Res. 2013 Oct;13(5):579-95
pubmed: 24138645
Dis Colon Rectum. 2017 Jan;60(1):107-115
pubmed: 27926564
Pharmacoeconomics. 2011 Mar;29(3):189-98
pubmed: 21309615
Med Decis Making. 1990 Jul-Sep;10(3):212-4
pubmed: 2115096
Health Econ. 1997 Jul-Aug;6(4):327-40
pubmed: 9285227
Hernia. 2017 Apr;21(2):163-175
pubmed: 28025739
Eur Urol. 2020 Nov;78(5):757-763
pubmed: 32800407
Pharmacoeconomics. 2011 Apr;29(4):287-96
pubmed: 21395349