SURGICAL OUTCOME AND COST-MINIMIZATION-ANALYSES OF LAPAROSCOPIC AND OPEN HERNIA REPAIR - A RANDOMIZED PROSPECTIVE TRIAL WITH ONE-YEAR FOLLOW-UP

Objective: To compare outcome and costs between laparoscopic and open hernia repair. Design: Prospective randomised study. Setting: One univ ersity and two district hospitals in Sweden. Subjects: 200 men aged 25 -75 years. Main outcome measures: Operating time, hospital stay, compl ications, and time to recovery. A cost-minimisation-analysis was used in which the total costs were calculated for a defined period of time for each option. Results: The one year follow-up rate was 98%. Mean (S D) operation times in the laparoscopic and open groups were 72 (30) an d 62 (25) minutes, respectively (p = 0.009). Hospital stay and complic ation rates did not differ between the groups. Among employees the mea n (SD) periods off work in the laparoscopic and open groups were 10 (8 ) and 23 (21) days, respectively (p = 0.0001). The mean direct costs o f the laparoscopic operation were increased by SEK 4037 (US$ 483) but the savings in indirect costs resulting from earlier return to work we re SEK 11392 (US$ 1364). Conclusions: Laparoscopic hernia repair gave the employed patients faster recovery and return to work, and was the most cost-effective strategy provided that both direct and indirect co sts were included.