Inguinal Hernia Repair Using Mosquito Mesh Cost-effective

By Will Boggs MD

March 10, 2017

NEW YORK (Reuters Health) - Inguinal hernia repair using mosquito mesh is a cost-effective alternative to using commercial mesh in low-income countries, according to an analysis of a randomized clinical trial.

Commercial mesh normally costs $100 or more, which is more than twice the cost of inguinal hernia repair in countries such as Uganda, Dr. Jenny Loefgren from Umea University in Sweden and colleagues write in the British Journal of Surgery, online February 16. Mosquito mesh, which is similar in structure to commercial mesh but at a fraction of its cost, has been shown to be a safe and effective alternative to commercially available mesh, they add.

The team compared the cost-effectiveness, from the care provider’s perspective, of groin hernia surgery using a low-cost mesh and a commercial mesh in their study of 302 patients in a rural setting in Uganda.

The cost of surgery was 352% higher in the commercial-mesh group than in the mosquito-mesh group. This amounted to an increase of $124.7 (118.1 euro) in a setting where the cost per bed-day is only $10 (9.5 euro).

The cost per quality-adjusted life-year (QALY) gained was $7.6 (7.2 euro) in the mosquito-mesh group and $33.3 (31.5 euro) in the commercial-mesh group, whereas the cost per disability-adjusted life-year (DALY) averted was $16.8 (15.9 euro) with mosquito mesh versus $58.2 (55.1 euro) with commercial mesh.

In sensitivity analyses, the lowest cost-effectiveness was with commercial mesh ($84.7, 80.2 euro per QALY gained and $148.4, 140.5 euro per DALY averted), and the highest cost-effectiveness was with mosquito mesh ($7.6, 7.2 euro per QALY gained and $16.8, 15.9 euro) per DALY averted).

“This study has shown that the best available method in open groin hernia repair, namely mesh repair, is highly cost-effective in the research setting,” the authors conclude. “The method compares favorably with other prioritized healthcare interventions and can potentially improve the lives of many millions of patients worldwide.”

“The method should therefore be included in plans to strengthen national and international health systems,” they add.

Dr. Urmas Lepner from Tartu University in Estonia, who has published extensively on hernia repair, told Reuters Health by email, “This clinical trial is of high quality and we have to take the conclusions of this study seriously.”

“However, one-year follow up after surgery is too short to draw the final conclusion,” he said. “Using mosquito mesh instead of commercial one seems to be a safe and cost-effective alternative in low- and middle-low income countries where the commercial mesh costs much more than the operation itself.”

Dr. Loefgren did not respond to a request for comments.

SOURCE: http://bit.ly/2lHsmTp

Br J Surg 2017.

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