Cost-effective of laparoscopic versus open groin hernia surgery in Colombia : an institutional perspective

Q3Q1Resumen289Introduction: Laparoscopic repair (LR) reveal clinical benefits above open repair (OR) of the groin hernia (QALY: LR: 0.84; OR: 0.83); however their cost-effectiveness is controversial. In both techniques, lightweight meshes (LWM) provide less postoperative pain, earlier labor return and QoL that heavyweight meshes (HWM). In Colombia, the OR+HWM has been currently performed, but LR (TAPP and TEP) is increasing. As well, there is not available information in Colombia of the cost-effectiveness of LR versus OR and available LWM. the aim of this study is to perform a comparison of four scenarios for treatment, based on technique and meshes, to identify the economic impact of the intervention through a cost-effective analysis. Methods: Retrospective analysis of economically active patients with primary unilateral hernia, submitted to OR+HWM from 2005-2010. Three economical scenarios were simulated (OR+LWM, TAPP+LWM and TAPP+HWM) and compared with OR+HWM, by the use of institutional costs. Direct and indirect costs, cost per QALY gained and incremental cost-effectiveness radio (ICER) were determinate for interventions. Work return in LR was assumed five days less than OR according to literature. the intervention was considered cost-effective if QALY value was less than three annual GNP per capita (29.000 USD). Results: 503 patients were submitted to OR+HWM. A mean of 12.3 days of labor return was identified. Total cost of treatment per patient was 564 USD (direct: 344; indirect: 220). Cost of treatment per patient on simulated scenarios was: OR+LWM: 607 USD (direct: 387; indirect: 220); TAPP+HWM: 1242 USD (direct: 1099; indirect: 143); and TAPP+LWM: 1285 USD (direct: 1142; indirect: 143). Main direct cost of treatment in LR was associated to surgical devices (fixation and harmonic scalpel). ICER for LR groups per QALY gained was highest that reference value (TAPP+HWM: 75.500 USD; TAPP+LWM:79.743 USD). The optimal ICER for LR (TAPP) is 638 USD. Conclusions: LR (TAPP) in Colombia is not a cost-effective treatment for groin hernia. Based in clinical advantages for the patient and face to the advances of LR, significant adjustments in direct cost by industry and negotiation policies among health system stakeholders are indispensable. Continuous training among surgeons is critical for develop of the LR. Further studies are necessary to evaluate the cost-effectiveness of other techniques as TEP in Colombia