Cost-utility analysis of open versus laparoscopic groin hernia repair:: results from a multicentre randomized clinical trial

Background: This study was a pragmatic economic evaluation carried out alongside a multicentre randomized controlled trial comparing laparoscopic with open groin hernia repair. The primary economic evaluation framework employed was a cost-utility analysis. Methods: At 26 hospitals in the UK and Ireland, 928 patients with a groin hernia were assigned randomly to laparoscopic or open repair. Cost data were identified and measured both within and outwith the trial, Cost data were combined with quality-adjusted life years (QALYs) from the EQ-5D questionnaire to obtain cost-per-QALY ratios. Results: The mean cost of laparoscopic hernia repair was pound 1112.64, compared with pound 788.79 for the open operation. The extra cost of pound 323.85 in the laparoscopic group was mainly due to additional theatre time and increased equipment and sterilization costs. The estimated incremental cost per QALY of the laparoscopic over the open method was pound 55 548.00 (95 per cent confidence interval pound 47 216.00-pound 63 885.00). Conclusion: While the results show that a high cost was incurred to produce an additional QALY by using laparoscopic over open hernia repair, sensitivity analyses show that there are specific situations in which laparoscopic repair may be a viable alternative, such as when reusable equipment is employed.