A Cost-Utility Analysis of Mesh Prophylaxis in the Prevention of Incisional Hernias following Stoma Closure Surgery

Yusuf Sheikh, Hareef Asunramu, Heather Low (), Dev Gakhar, Keerthi Muthukumar, Husam Yassin and Laure de Preux
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Yusuf Sheikh: Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK
Hareef Asunramu: Faculty of Medicine, Imperial College London, London SW7 2DD, UK
Heather Low: Faculty of Medical Sciences, University College London, London WC1E 6DE, UK
Dev Gakhar: Faculty of Medicine, Imperial College London, London SW7 2DD, UK
Keerthi Muthukumar: Faculty of Medicine, Imperial College London, London SW7 2DD, UK
Husam Yassin: Faculty of Medicine, Imperial College London, London SW7 2DD, UK

IJERPH, 2022, vol. 19, issue 20, 1-15

Abstract: Background: Stoma closure is a widely performed surgical procedure, with 6295 undertaken in England in 2018 alone. This procedure is associated with significant complications; incisional hernias are the most severe, occurring in 30% of patients. Complications place considerable financial burden on the NHS; hernia costs are estimated at GBP 114 million annually. As recent evidence (ROCSS, 2020) found that prophylactic meshes significantly reduce rates of incisional hernias following stoma closure surgery, an evaluation of this intervention vs. standard procedure is essential. Methods: A cost-utility analysis (CUA) was conducted using data from the ROCSS prospective multi-centre trial, which followed 790 patients, randomly assigned to mesh closure ( n = 394) and standard closure ( n = 396). Quality of life was assessed using mean EQ-5D-3L scores from the trial, and costs in GBP using UK-based sources over a 2-year time horizon. Results: The CUA yielded an incremental cost-effectiveness ratio (ICER) of GBP 128,356.25 per QALY. Additionally, three univariate sensitivity analyses were performed to test the robustness of the model. Conclusion: The results demonstrate an increased benefit with mesh prophylaxis, but at an increased cost. Although the intervention is cost-ineffective and greater than the ICER threshold of GBP 30,000/QALY (NICE), further investigation into mesh prophylaxis for at risk population groups is needed.

Keywords: stoma closure; incisional hernia; mesh prophylaxis; cost-utility analysis (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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