COST-EFFECTIVENESS OF EXTRAPERITONEAL LAPAROSCOPIC INGUINAL-HERNIA REPAIR - A RANDOMIZED COMPARISON WITH CONVENTIONAL HERNIORRHAPHY

Objective To determine the cost-effectiveness of laparoscopic inguinal hernia repair. Summary Background Data Laparoscopic inguinal hernia r epair seems superior to open techniques with respect to short-term res ults. An issue yet to be studied in depth remains the cost-effectivene ss of the procedure. As part of a multicenter randomized study in whic h >1000 patients were included, a cost-effectiveness analysis from a s ocietal point of view was performed. Methods After informed consent, a il resource costs, both in and outside the hospital, for patients betw een August 1994 and July 1995 were recorded prospectively. Actual cost s were calculated in a standardized fashion according to international guidelines. The main measures used for the evaluation of inguinal her nia repair were the number of averted recurrences and quality of life measured with the Short Form 36 questionnaire. Results Resource costs were recorded for 273 patients, 139 in the open and 134 in the laparos copic group. Both groups were comparable al baseline. Average total ho spital costs were Dfl 1384.91 (standard deviation: Dfl 440.15) for the open repair group and Dfl 2417.24 (standard deviation: Dfl 577.10) fo r laparoscopic repair, including a disposable kit of Dfl 676. Societal costs, including costs for days of sick leave, were lower for the lap aroscopic repair and offset the hospital costs by Dfl 780.83 (75.6%), leaving the laparoscopic repair Dfl 251.50 more expensive (Dfl 4685 ve rsus Dfl 4916.50). At present, the recurrence rate is 2.6% lower after laparoscopic repair. Thus, 38 laparoscopic repairs, costing an additi onal Dfl 9,557, prevent the occurrence of one recurrent hernia. Qualit y of life was better after laparoscopic repair. Conclusion A better qu ality of life in the recovery period and the possibility of replacing parts of the disposable kit with reusable instruments may result in th e laparoscopic repair becoming dominantly better-that is, less expensi ve and more effective from a societal perspective.