Lawrence Lee1, Abdulaziz Saleem2, Tara Landry3, Eric Latimer4, Prosanto Chaudhury2, Liane S Feldman5. 1. Steinberg-Bernstein Centre for Minimally-Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada. 2. Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada. 3. Montreal General Hospital Library, McGill University Health Centre, Montreal, Quebec, Canada. 4. Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada. 5. Steinberg-Bernstein Centre for Minimally-Invasive Surgery and Innovation, McGill University Health Centre, Montreal, Quebec, Canada; Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada. Electronic address: liane.feldman@mcgill.ca.
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$10,818 per quality-adjusted life year. On sensitivity analyses, the decision was sensitive to the probability of mesh infection and the cost of the mesh, and method of diagnosing PSH. CONCLUSIONS: In patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer, mesh prophylaxis might be the less costly and more effective strategy compared with no mesh to prevent PSH in patients with stage I to III disease, and might be cost effective in patients with stage IV disease.
BACKGROUND:Parastomal hernia (PSH) is common after stoma formation. Studies have reported that mesh prophylaxis reduces PSH, but there are no cost-effectiveness data. Our objective was to determine the cost effectiveness of mesh prophylaxis vs no prophylaxis to prevent PSH in patients undergoing abdominoperineal resection with permanent colostomy for rectal cancer. STUDY DESIGN: Using a cohort Markov model, we modeled the costs and effectiveness of mesh prophylaxis vs no prophylaxis at the index operation in a cohort of 60-year-old patients undergoing abdominoperineal resection for rectal cancer during a time horizon of 5 years. Costs were expressed in 2012 Canadian dollars (CAD$) 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.
Authors: S A Antoniou; F Agresta; J M Garcia Alamino; D Berger; F Berrevoet; H-T Brandsma; K Bury; J Conze; D Cuccurullo; U A Dietz; R H Fortelny; C Frei-Lanter; B Hansson; F Helgstrand; A Hotouras; A Jänes; L F Kroese; J R Lambrecht; I Kyle-Leinhase; M López-Cano; L Maggiori; V Mandalà; M Miserez; A Montgomery; S Morales-Conde; M Prudhomme; T Rautio; N Smart; M Śmietański; M Szczepkowski; C Stabilini; F E Muysoms Journal: Hernia Date: 2017-11-13 Impact factor: 4.739
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Authors: Huw G Jones; Michael Rees; Omar M Aboumarzouk; Joshua Brown; James Cragg; Peter Billings; Ben Carter; Palanichamy Chandran Journal: Cochrane Database Syst Rev Date: 2018-07-20