Skip Navigation LinksHome > January 2014 - Volume 133 - Issue 1 > Complex Ventral Hernia Repair Using Components Separation wi...
Plastic & Reconstructive Surgery:
doi: 10.1097/01.prs.0000436835.96194.79
Reconstructive: Trunk: Outcomes Article

Complex Ventral Hernia Repair Using Components Separation with or without Synthetic Mesh: A Cost-Utility Analysis

Chatterjee, Abhishek M.D., M.B.A.; Krishnan, Naveen M. B.S., M.Phil.; Rosen, Joseph M. M.D.

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Abstract

Background: Components separation provides a useful option among closure choices for complex ventral hernia repairs. The use of synthetic mesh in addition to performing a components separation is controversial. The authors’ goal was to perform the first cost-utility analysis on the use of synthetic mesh in addition to performing components separation when performing a complex ventral hernia repair in a noncontaminated field.

Methods: A comprehensive literature review was conducted to identify published complication and recurrence rates for ventral hernia repairs (Ventral Hernia Workgroup I and II) requiring components separation with or without synthetic mesh. The probabilities of the most common complications were combined with Medicare Current Procedural Terminology reimbursement codes, Diagnosis-Related Group reimbursement codes, and expert utility estimates to fit into a decision model to evaluate the cost-effectiveness of components separation with and without synthetic mesh in reconstructing ventral hernias.

Results: At average retail costs, the decision model revealed a cost increase of $541.69 and a 0.0357 increase in quality-adjusted life-years when using synthetic mesh, yielding a cost-effective incremental cost-utility ratio of $15,173.39 per quality-adjusted life-year. Univariate sensitivity analysis revealed that synthetic mesh is cost-effective when it costs less than $2049.97.

Conclusions: The addition of synthetic mesh when performing components separation in repairing complex ventral hernias is cost-effective when using average retail prices. Physicians and hospitals should use synthetic mesh in patients with noncontaminated wounds.

©2014American Society of Plastic Surgeons

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