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A cost-utility analysis of mesh prophylaxis in the prevention of incisional hernias following stoma closure surgery

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Title: A cost-utility analysis of mesh prophylaxis in the prevention of incisional hernias following stoma closure surgery
Authors: Sheikh, Y
Asunramu, H
Low, H
Gakhar, D
Muthukumar, K
Yassin, H
De Preux, L
Item Type: Journal Article
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.
Issue Date: 19-Oct-2022
Date of Acceptance: 14-Oct-2022
URI: http://hdl.handle.net/10044/1/100343
DOI: 10.3390/ijerph192013553
ISSN: 1660-4601
Publisher: MDPI AG
Start Page: 1
End Page: 15
Journal / Book Title: International Journal of Environmental Research and Public Health
Volume: 19
Issue: 20
Copyright Statement: © 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Keywords: Toxicology
Publication Status: Published
Online Publication Date: 2022-10-19
Appears in Collections:Imperial College Business School



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