Cost effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing permanent colostomy for rectal cancer.

TitleCost effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing permanent colostomy for rectal cancer.
Publication TypeJournal Article
Year of Publication2014
AuthorsLee L, Saleem A, Landry T, Latimer E, Chaudhury P, Feldman LS
JournalJ Am Coll Surg
Volume218
Issue1
Pagination82-91
Date Published2014 Jan
ISSN1879-1190
KeywordsCanada, Colostomy, Cost-Benefit Analysis, Health Care Costs, Hernia, Ventral, Humans, Markov Chains, Middle Aged, Models, Economic, Neoplasm Staging, Postoperative Complications, Quality-Adjusted Life Years, Rectal Neoplasms, Surgical Mesh, Surgical Stomas
Abstract

BACKGROUND: Parastomal hernia (PSH) is common after stoma formation. Studies have reported that mesh prophylaxis reduces PSH, but there are no cost-effectiveness data. Our objective was to determine the cost effectiveness of mesh prophylaxis vs no prophylaxis to prevent PSH in patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer.STUDY DESIGN: Using a cohort Markov model, we modeled the costs and effectiveness of mesh prophylaxis vs no prophylaxis at the index operation in a cohort of 60-year-old patients undergoing abdominoperineal resection for rectal cancer during a time horizon of 5 years. Costs were expressed in 2012 Canadian dollars (CAD$) and effectiveness in quality-adjusted life years. Deterministic and probabilistic sensitivity analyses were performed.RESULTS: In patients with stage I to III rectal cancer, prophylactic mesh was dominant (less costly and more effective) compared with no mesh. In patients with stage IV disease, mesh prophylaxis was associated with higher cost (CAD$495 more) and minimally increased effectiveness (0.05 additional quality-adjusted life years), resulting in an incremental cost-effectiveness ratio of CAD$10,818 per quality-adjusted life year. On sensitivity analyses, the decision was sensitive to the probability of mesh infection and the cost of the mesh, and method of diagnosing PSH.CONCLUSIONS: In patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer, mesh prophylaxis might be the less costly and more effective strategy compared with no mesh to prevent PSH in patients with stage I to III disease, and might be cost effective in patients with stage IV disease.

DOI10.1016/j.jamcollsurg.2013.09.015
Alternate JournalJ. Am. Coll. Surg.
PubMed ID24210147