Cost-utility analysis of repair of reducible ventral hernia.

Abstract

Patient-reported outcomes are an important metric of the effectiveness of care. Ventral hernia repair is a procedure where the effectiveness can best be quantified using health-related quality of life. This study sought to quantify quality of life with respect to costs of ventral hernia repair. This observational study of patients diagnosed with a ventral hernia between 2004-2011 in a single center identified 3 groups of patients: (1) Patients diagnosed with ventral hernias managed with observation, (2) patients diagnosed with ventral hernias who underwent operative repair only when incarceration occurred, and (3) patients with ventral hernias who underwent herniorraphy before incarceration. The Short Form (SF)12v2 was administered to measure quality of life. The direct costs of care were obtained from Financial Services. Patients were surveyed about direct, non-health costs to obtain a societal perspective. A cost-utility analysis was performed. The SF-12v2 was administered to 243 patients; 80 were observed, 69 underwent repair of an incarcerated hernia, and 94 underwent repair of a nonincarcerated hernia. The response rates were similar among groups-59%, 55%, and 52%. Quality of life as measured by utility score was less at 0.68 (95% CI, 0.65-0.71) in patients who did not undergo repair compared with those after repair of a nonincarcerated hernia, 0.76 (95% CI, 0.73-0.79; P < .001). The elective repair of a nonincarcerated hernia was cost-effective with an incremental cost effectiveness ratio of $8,646 per quality-adjusted life-year. The prompt elective repair of ventral hernias is cost-effective.