Saha Sanjib, Gerdtham Ulf, Bläckberg Mats, Kollberg Petter, Liedberg Fredrik
Health Economics Unit, Department of Clinical Sciences (Malmö), Lund University, Lund, Sweden.
Department of Economics, Lund University, Lund, Sweden.
Eur Urol Open Sci. 2022 Apr 21;40:9-15. doi: 10.1016/j.euros.2022.03.011. eCollection 2022 Jun.
Prophylactic lightweight mesh in the sublay position reduced the cumulative incidence of parastomal hernia (PSH) after cystectomy with ileal conduit diversion in a randomised controlled trial.
To investigate whether the use of prophylactic mesh is cost-effective in comparison to no mesh from the health care provider perspective.
Data on health care resource utilisation (outpatient care and inpatient care) were obtained for 159 patients included in a randomised trial. The patients underwent surgery at Skåne University Hospital or Helsingborg County Hospital (80 with a prophylactic mesh and 79 without) and information about care was ascertained from the regional health care register. The patients underwent surgery between 2012 and 2017 and were followed until death or August 2020.
The primary outcome measure was the clinical incidence of PSH. Costs are reported in Euro in 2020 prices (€1 = 10.486 Swedish Krona) and presented as the incremental cost-effectiveness ratios (ICERs) with confidence intervals (CIs) calculated using a nonparametric bootstrap procedure. Sensitivity analyses and subgroup analyses were performed to capture the uncertainty for ICERs.
The mean difference in total costs between the mesh and no-mesh groups was -€2047 (95% CI -€16 441 to €12 348). Seventeen patients (21.5%) in the no-mesh group developed clinical PSH versus six patients (7.5%) in the mesh group ( = 0.001). This indicates that mesh is less costly and more effective compared to no mesh from the health care provider perspective. Subgroup analyses showed that results were more advantageous for women and for patients younger than 71 yr and with less comorbidity than for their counterparts.
The use of prophylactic mesh during ileal conduit reconstruction to prevent PSH is cost-effective from the health care provider perspective.
In patients having their bladder surgically removed, a mesh implant can be inserted when a portion of the intestine is used to create an opening to drain urine from the body. Our results show that mesh use to prevent development of a hernia at the opening where urine exits the body is cost-effective from the perspective of health care providers.
在一项随机对照试验中，在耻骨后间隙放置预防性轻质补片可降低膀胱切除术后回肠代膀胱造口旁疝（PSH）的累积发生率。
从医疗保健提供者的角度，研究使用预防性补片与不使用补片相比是否具有成本效益。
设计、地点和参与者：从一项随机试验纳入的159例患者中获取医疗保健资源利用（门诊和住院治疗）数据。这些患者在斯坎纳大学医院或赫尔辛堡县医院接受手术（80例使用预防性补片，79例未使用），护理信息从地区医疗保健登记处获取。患者于2012年至2017年接受手术，并随访至死亡或2020年8月。
主要结局指标是PSH的临床发生率。成本以2020年价格的欧元报告（1欧元 = 10.486瑞典克朗），并以增量成本效益比（ICER）表示，其置信区间（CI）使用非参数自助法计算。进行敏感性分析和亚组分析以捕捉ICER的不确定性。
补片组和无补片组的总成本平均差异为-2047欧元（95%CI -16441欧元至12348欧元）。无补片组17例患者（21.5%）发生临床PSH，而补片组为6例患者（7.5%）（P = 0.001）。这表明从医疗保健提供者的角度来看，补片成本更低且更有效。亚组分析表明，与相应人群相比，女性、年龄小于71岁且合并症较少的患者结果更有利。
从医疗保健提供者的角度来看，在回肠代膀胱重建术中使用预防性补片预防PSH具有成本效益。
在接受膀胱手术切除的患者中，当使用一部分肠道来创建一个开口以排出体内尿液时，可以植入补片。我们的结果表明，从医疗保健提供者的角度来看，使用补片预防尿液排出体外的开口处发生疝气具有成本效益。
