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Use of a global economic model to analyze the cost-benefit of AlloDerm in Ventral Hernia Repair.
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LifeCell Clinical Monograph Series, 2005.
Ronald N. Kaleya, MD
Beth Israel Medical Center
New York, NY
Richard Thomas
Lehmann Thomas, LLC
Abstract:
A cost-benefit assessment for surgical technologies is related to not only hospital and OR costs but, in our estimation, should consider other cost influences, including procedure-related patient morbidity, short-term and long-term postsurgical complications, the need for multiple surgeries to repair failure of the index operation, and productivity losses. The repair of incisional hernia with primary closure or synthetic mesh, for instance, has been associated with poor long-term reliability related to recurrence, infection, seromas, adhesions, and fistulas. These complications can provoke additional expenses for postsurgical medical management and/or reoperation. We perceive, therefore, that these expenses are part of the global cost-effectiveness of an individual approach and should be considered when evaluating alternate repair methods.
We have developed a dynamic model for determining cost-effectiveness of surgical interventions that incorporates the frequently overlooked expenses related to postsurgical complications and secondary procedures related to invasive surgeries. We then applied this model to a comparative assessment of incisional hernia repair costs using a traditional synthetic prosthetic material (polypropylene mesh) versus AlloDerm® (LifeCell Corporation, Branchburg, NJ) a biologic, human tissue-derived matrix. This more inclusive assessment of cost-center, hospital, insurer, and societal healthcare expenses associated with hernia repair surgery reveals that when the long-term costs for follow-up care and subsequent interventions are considered in a cost-effectiveness analysis, the higher initial costs for AlloDerm are offset by the increased risk of common complications associated with other techniques and the additional management costs and quality of life impairments associated with these outcomes. |
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