Cost-conscious decisions in the timing of operation for minimally symptomatic inguinal hernias in male patients - 15/05/16
Abstract |
Background |
Expectant management (EM) and early open repair (OR) are safe and effective as initial management strategies for minimally symptomatic inguinal hernia in male patients. Extended follow-up of patients in EM protocols have shown that most patients will eventually require repair, but it is not clear which strategy is less costly over the long term.
Methods |
We constructed a mathematical model to compare 3rd-party payer expenditures for EM vs OR or laparoscopic repair in a simulated cohort of patients with inguinal hernia. Cohort characteristics and expenditures were calibrated to recent randomized trials that reported initial follow-up and expenditures at 2 years and long-term crossover rates from EM to OR.
Results |
Cost comparisons between OR and EM are sensitive to direct long-term costs of inpatient and outpatient care, the likelihood of crossover from EM to operation, cost differences between OR and laparoscopic repair, and the net present value of longer-term costs.
Conclusions |
Our findings suggest that short-term costs of EM are less than those of OR and Lap-R, but early OR provides the highest long-term savings.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Most male patients with asymptomatic inguinal hernia will require repair. |
• | Mathematical models suggest that early repair is less costly to payers than expectant management. |
• | Over a ten-year cycle of care, the net present value of money influences overall cost of care. |
Keywords : Inguinal hernia, Open tension-free repair, Laparoscopic repair, Expectant management, Observation, Net present value
Plan
| No sponsorship of this study from any industry ororganizations. The work was completely supported through the David L. Nahrwold Endowment and the Academic Enrichment Fund of the Department of Surgery at Penn State College of Medicine and the Milton S. Hershey Medical Center. |
Vol 211 - N° 6
P. 975-981 - juin 2016 Retour au numéro
Article précédent
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