A Cost-Utility Assessment of Mesh Selection in Clean-Contaminated Ventral Hernia Repair

Fischer, John P.; Basta, Marten N.; Krishnan, Naveen M.; Wink, Jason D.; Kovach, Stephen J.

doi:10.1097/01.prs.0000475775.44891.56

Cited by 55 publications

(27 citation statements)

References 49 publications

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“…Available evidence is somewhat conflicting with several studies identifying increased costs associated with the use of biological grafts [29,30]. Conversely, more recent literature has identified no significant cost increase associated with the use of biological grafts when assessing use in infected wounds [31] or departmental revenue [32]. Accordingly, Huerta et al concluded that there exists no high-quality clinical trial to demonstrate the costbenefits of biological materials [27].…”

Section: Discussionmentioning

confidence: 95%

Ventral hernia repair with lateral component separation and onlay Biodesign graft

et al. 2016

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Background Ventral hernia is common, complicating up to 20 % of laparotomies. Plication of the rectus sheath with lateral component separation (LCS) provides a durable repair with acceptable functional outcomes. Additional support to the anterior abdominal wall may be provided by synthetic or biological mesh. Biological grafts invoke local tissue remodeling and result in strong fibrocollagenous tissue able to support the dynamic stressor of the anterior abdominal wall. Biodesign graft is a new graft derived from porcine smallintestine submucosa. We aim to review the use of Biodesign mesh for repair of ventral hernia with LCS. Methods Patients underwent ventral hernia repair completed with plication of the rectus sheath, LCS, and use of an onlay Biodesign graft. Data was collected retrospectively. Key outcome measures included post-operative complications and recurrence. Results Twelve patients were included for analysis. Mean age was 51.2 years, with 50 % males and a median weight of 87 kg (65-111 kg). Median operative time was 210 min (147 to 278 min) and median length of stay was 4 days. At a mean follow-up of 14.0 months, 8/12 (66 %) developed seroma, 1/12 (8 %) developed abdominal wall abscess, and 1/12 (8 %) suffered flap failure requiring vacuum dressings for closure. No patients were complicated by ventral hernia recurrence. Conclusions Our results describe an early Australian experience of onlay Biodesign graft in the context of rectus sheath plication with LCS. We report acceptable rates of postoperative complications and recurrence. Level of evidence: IV, therapeutic study.

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Section: Discussionmentioning

confidence: 95%

Ventral hernia repair with lateral component separation and onlay Biodesign graft

et al. 2016

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“…A cost-utility analysis is commonly used to determine the cost of particular interventions in terms of their utility, which includes quantity needed over a lifetime as well as quality of life. It has been used in a variety of surgical studies to date and have helped inform surgeon decisions Chatterjee et al, 2014;Fischer et al, 2016;Krishnan et al, 2016;Krishnan et al, 2015;Krishnan et al, 2014;Offodile et al, 2015;Thoma et al, 2012;Sheckter et al, 2018). Such a technique allows for identification of interventions with the best clinical outcomes and best value, which is especially important with the large healthcare costs associated with breast oncology management (Lang et al, 2014;Bekelman et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Cost-Effectiveness of the Biozorb Device for Radiation Planning in Oncoplastic Surgery

Rashad¹,

Huber²,

Chatterjee³

2018

CCO

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Purpose: With the extent of breast tissue manipulation using oncoplastic surgical techniques, there lies a challenge in marking the tumor bed for adjuvant radiation therapy planning. Two competing techniques in doing so exist and involve the traditional placement of surgical clips in the surgical tumor bed or the newer technique of placing a Biozorb marker in the tumor bed. Our goal was to perform a cost-utility assessment to see which tumor bed marking approach is more cost-effective. Based on device list prices and clinical outcomes from a comprehensive literature review, we assessed if an approach either dominated or had an incremental cost-utility ratio of less than $50,000/QALY since either would signify cost-effectiveness. Results: From a cost comparison, the Biozorb marker ($1250) was far costlier than the clip applier device ($50). Our PRISMA search (Figure 1) reviewed 133 articles for clip placement and 42 articles for Biozorb placement in oncoplastic surgery with 2 clip placement articles and 3 Biozorb articles meeting criteria. The available data for either marking technique suggests reasonable tumor bed identification for adjuvant radiation treatment without clear clinical advantages supporting one technique over the other. Overall clinical equivalence in the setting of a clear cost advantage suggests dominant cost-effectiveness in favor of clips. Conclusion: Using surgical clips to identify the tumor bed in oncoplastic surgery is dominant and more cost-effective over the Biozorb technique as clips are relatively inexpensive while both techniques reasonably identify the tumor bed.

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“…24 The main disadvantage of these biologic implants is their significantly higher cost compared with synthetic mesh. 38 As a result, surgeons are often faced with deciding between higher wound complications or higher costs in dirty and contaminated wounds. With new innovations in biosynthetic meshes, which appear to have similar anti-infection properties as biologic meshes at a reduced cost, studies such as the Contaminated Ventral Hernia Repair Using Biosynthetic Absorbable Mesh (COBRA) trial are showing comparable recurrence rates to synthetic mesh with improved quality of life; however, long-term outcomes and cost-effectiveness still need to be assessed.…”

Section: Component Separationmentioning

confidence: 99%

Retromuscular Sublay Technique for Ventral Hernia Repair

Rhemtulla

Fischer

2018

Seminars in Plastic Surgery

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Rives and Stoppa described the sublay technique of hernia repair more than half a century ago, but it took almost three decades to become truly appreciated and even longer for its full clinical potential and benefits to be realized. Modifications to the original operation have significantly improved surgical approaches, postsurgical outcomes, and quality of life. The retromuscular approach requires technical expertise and a firm grasp of the anatomy. With constant substitution of the terms sublay, retrorectus, retromuscular, preperitoneal, and Rives-Stoppa throughout the literature, the nuances need to be distinguished to appreciate the surgical planes encountered during the operation. This article explains the origin of the nomenclature while clarifying these terms, describing the technique, highlighting outcomes, and discussing future considerations.

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A Cost-Utility Assessment of Mesh Selection in Clean-Contaminated Ventral Hernia Repair

Abstract: This cost-utility analysis suggests that synthetic mesh repair of clean-contaminated hernia defects is more cost-effective than acellular dermal matrix.

Cited by 55 publications

References 49 publications

Ventral hernia repair with lateral component separation and onlay Biodesign graft

Ventral hernia repair with lateral component separation and onlay Biodesign graft

Cost-Effectiveness of the Biozorb Device for Radiation Planning in Oncoplastic Surgery

Retromuscular Sublay Technique for Ventral Hernia Repair

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