Resumo

PINZON, Fabio Eduardo; RINCON, Francisco Mauricio; ESPITIA, Erick  e  DOMINGUEZ, Luis Carlos. Open versus laparoscopic herniorrhaphy with new prosthetic materials: analysis of clinical and economic effectiveness for the patient, the hospital and the health care system. rev. colomb. cir. [online]. 2011, vol.26, n.4, pp.242-259. ISSN 2011-7582.

Introduction: Laparoscopic repair (LR) of groin hernias has demonstrated clinical benefits over open repair (OR) (QALY: LR: 0.84; OR: 0.83). However, the cost-effectiveness is controversial. In both techniques, lightweight meshes (LWM) provide less postoperative pain, earlier return to work and better quality of life in comparison with heavyweight meshes (HWM). In Colombia, the OR+HWM has been currently performed, but LR (TAPP and TEP) is increasingly used, although there is no available information on the cost-effectiveness of LR versus OR and LWM. The aim of this study was to compare four scenarios for treatment, based on technique and meshes, in order to identify the economic impact of the intervention through a cost-effective analysis. Methods: Retrospective analysis of economically active patients with primary unilateral hernia subjected to OR+HWM in the period 2005-2010. Three economical scenarios were simulated (OR+LWM, TAPP+LWM and TAPP+HWM) and compared with OR+HWM, based on institutional costs. Direct and indirect costs, cost per QALY gained and incremental cost-effectiveness (ICER) were determinate for the interventions. Return to work in LR was assumed five days less than in 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 subjected to OR+HWM. A mean of 12.3 days before return to normal work was registered. 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 appeared related to the surgical devices (staplers and harmonic scalpel). ICER for LR groups per QALY gained was highest than 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 on clinical advantages for the patient and facing the technological 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 the full development of the LR. Further studies are necessary to evaluate the cost-effectiveness of other techniques as TEP in Colombia.

Palavras-chave : hernia; inguinal; surgery; laparoscopy; prostheses and implants; cost-benefit analysis.

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