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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.

Plastic and Reconstructive Surgery: January 2014 - Volume 133 - Issue 1 - p 137–146
doi: 10.1097/01.prs.0000436835.96194.79
Reconstructive: Trunk: Outcomes Article

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.

Lebanon, N.H.

From the Dartmouth Hitchcock Medical Center.

Received for publication April 13, 2012; accepted July 23, 2013.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Abhishek Chatterjee, M.D., M.B.A., Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, N.H. 03756,

©2014American Society of Plastic Surgeons