[Prosthetic mesh for hernia repair: which mesh for which indication? Analysis of the Committee for the Assessment of Devices and Health Technologies of the French National Authority for Health (HAS). Assessment of prosthetic meshes for hernia repair].

UNLABELLED

The Committee for the Assessment of Devices and Health Technologies (CEPP), one of the specialist committees of the French National Authority for Health (HAS), reassessed the use of prosthetic mesh for hernia repair in 2008. Mesh use is reimbursed by French national health insurance for use in adult and pediatric surgery. This reassessment had two primary purposes: (a) to define the indications and clinical situations justifying the use of mesh, and to describe the technical requirements; (b) to define the conditions of prescriptions and of use and to contribute to decisions for the renewal of inscription.

METHODS

We performed a systematic review of published data and manufacturers' licenses and applied the judgment of a multidisciplinary working group of involved healthcare professionals. The CEPP first analyzed the different sorts of prosthetic mesh according to operative indications; they then compared the performance of each prosthesis based on comparative data from the literature or based on expert opinion when there was no available comparative data. The committee recommended three types of prosthesis: flat patch mesh, three-dimensional mesh (plug), and double-sided patch. Additional studies were recommended to confirm the benefits of selected products. The cost of meshes has been integrated into the reimbursement of each Diagnostic Related Group (DRG) and is no longer included in the List of Reimbursable Products and Services (Liste des produits et prestations remboursables [LPPR]); the High Authority for Health (HAS) recommends the selection of those prostheses evaluated by the CEPP in order to optimize the quality and cost of health care.