Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management, Milano, Italy.
CTO - Azienda Ospedaliera dei Colli, Napoli, Italy.
Clin Ther. 2018 Nov;40(11):1830-1844.e4. doi: 10.1016/j.clinthera.2018.09.003. Epub 2018 Oct 20.
With the development of newer prostheses for hernia repair, it is nowadays difficult to understand the total cost of managing patients treated with these advanced medical devices, especially in the complex abdomen, in which various complications may occur. The aim of this study was to determine the economic implications of these prostheses in order to inform decision making in the management of incisional hernia repair.
A budget impact analysis model was developed to evaluate the economic consequences related to the management of patients undergoing complex (Centers for Disease Control and Prevention wound class II-III or Ventral Hernia Working Group grade 2/3) incisional hernia repair through biosynthetic, synthetic, or biological meshes, from the hospital perspective in Italy. The model was populated with complication rates mainly retrieved from the literature to compare the current scenario with 60%, 10%, and 30% rates of synthetic, biosynthetic, and biological mesh utilization, respectively, with future hypothetical scenarios that consider increasing rates of biosynthetic mesh utilization with respect to the other types of mesh in the next 5 years. Hospital costs of the different events were estimated based on health care resource consumption derived from an electronic survey addressed to key opinion leaders in the field.
The analysis compared the current scenario with future hypothetical scenarios that consider increasing utilization rates of biosynthetic meshes of 25%, 38%, and 44% in the next 1, 3, and 5 years, as estimated by clinicians. Considering 40,000 incisional hernia repairs per year, an increasing use of the biosynthetic meshes may result in a decrease in the total hospital budget of about €153 million in the next 5 years, with a savings per patient of about €770.
The findings of this study support the use of biosynthetic meshes for complex abdominal wall repairs in Italy, showing a potential decrease in the hospital budget in Italy after the diffusion of the new biosynthetic prostheses. Further studies and data from clinical practice would provide additional information to increase the understanding of the economic sustainability of these advanced devices.
随着疝修补术新型假体的发展，如今难以理解使用这些先进医疗器械治疗患者的总成本，尤其是在可能发生各种并发症的复杂腹部。本研究旨在确定这些假体的经济影响，以便为切口疝修补术的管理决策提供信息。
从意大利医院的角度出发，开发了一种预算影响分析模型，以评估与使用生物合成、合成或生物网片治疗复杂（疾病控制与预防中心伤口分类 II-III 级或腹疝工作组 2/3 级）切口疝患者相关的经济后果。该模型采用主要从文献中检索到的并发症发生率进行填充，以比较当前情况与分别为 60%、10%和 30%的合成、生物合成和生物网片使用率的情况，以及考虑未来假设情况，即在未来 5 年内，生物合成网片的使用率将相对于其他类型的网片增加。根据来自电子调查的医疗资源消耗，基于来自电子调查的医疗资源消耗，估计不同事件的医院成本，该调查针对该领域的主要意见领袖。
该分析将当前情况与未来假设情况进行了比较，未来假设情况考虑了未来 1、3 和 5 年内生物合成网片使用率分别增加 25%、38%和 44%，这是临床医生的估计。考虑到每年有 4 万例切口疝修复，在未来 5 年内，生物合成网片的使用增加可能会导致医院总预算减少约 1.53 亿欧元，每位患者的节省约为 770 欧元。
本研究的结果支持在意大利使用生物合成网片治疗复杂腹壁修复，表明在新型生物合成假体普及后，意大利医院的预算可能会减少。进一步的研究和来自临床实践的数据将提供更多信息，以增加对这些先进设备经济可持续性的理解。
