Department of Trauma and Reparative Medicine, CLINTEC, Karolinska Institute, Karolinska University Hospital, Sweden.
Department of Clinical Science and Education Södersjukhuset, Karolinska Institute, Sweden.
BJS Open. 2021 May 7;5(3). doi: 10.1093/bjsopen/zrab026.
The aim was to compare cost-effectiveness of Lichtenstein under local anaesthesia (LLA) with total extraperitoneal repair (TEP) under general anaesthesia for primary inguinal hernia in men. An endoscopic approach to inguinal hernia repair is often considered costlier. The cost of endoscopic hernia repair, however, has not been compared to open inguinal hernia repair in a cost-effective setting.
Data from an RCT comparing TEP and Lichtenstein in a cost-effective setting, with health economy as a secondary endpoint, were used. Data on costs were collected prospectively. Data on sick leave were obtained from the Swedish Social Insurance Agency in order to compare lengths of sick leave.
In total, 384 patients were included and 374 (97.4 per cent) patients were available for analysis, 189 in the LLA group and 185 in the TEP group. The median operating time for LLA was 70 (i.q.r. 60-80) min compared with 60 (i.q.r. 50-75) min in the TEP group (P < 0.001). The median time in operating theatre was 114 (i.q.r. 95--125) min for LLA and 125 (i.q.r. 110-145) min for TEP (P < 0.001). The median cost including all materials was 2433 (i.q.r. 2084-2734) Euros for LLA and 2395 (i.q.r. 2093-2784) Euro for TEP (P = 0.650). Mean sick leave was 4.2 days in the LLA group and 6.2 days in the TEP group (P = 0.830).
The overall cost to the hospital or length of sick leave did not differ between LLA and TEP.
本研究旨在比较局部麻醉下的 Lichtenstein 修补术（LLA）与全身麻醉下的完全腹膜外修补术（TEP）治疗男性原发性腹股沟疝的成本效果。虽然经内镜腹股沟疝修补术通常被认为费用更高，但在成本效益方面，尚未将其与开放式腹股沟疝修补术进行比较。
本研究使用了一项 RCT 的数据，该 RCT 在成本效益方面比较了 TEP 和 Lichtenstein，将健康经济学作为次要终点。前瞻性收集成本数据。通过向瑞典社会保险局（Swedish Social Insurance Agency）获取病假数据，以比较病假时长。
共纳入 384 例患者，其中 374 例（97.4%）患者可用于分析，LLA 组 189 例，TEP 组 185 例。LLA 组的中位手术时间为 70（IQR 60-80）min，TEP 组为 60（IQR 50-75）min（P<0.001）。LLA 组的中位手术时间为 114（IQR 95-125）min，TEP 组为 125（IQR 110-145）min（P<0.001）。包括所有材料在内的中位总成本为 LLA 组 2433（IQR 2084-2734）欧元，TEP 组 2395（IQR 2093-2784）欧元（P=0.650）。LLA 组的平均病假天数为 4.2 天，TEP 组为 6.2 天（P=0.830）。
LLA 和 TEP 之间的医院总成本或病假长度没有差异。
