Clinical and economic evaluation of the effectiveness of tension-free methods of inguinal hernioplasty

The OBJECTIVE was to determine the optimal approaches to the choice of the method of tension-free inguinal hernioplasty based on the clinical and economic analysis.

METHODS AND MATERIALS. A comparative study of the results of treatment of 95 male patients with primary unilateral inguinal hernia using the Lichtenstein method and TAPP was carried out. Before surgery and a year later, patients’ quality of life parameters were assessed using the EQ-5D questionnaire and used to calculate QALY (Quality Adjusted Life Years), the growth of which during the year served as a criterion for the effectiveness of the analyzed surgical technologies. A cost-utility analysis was carried out using direct costs.

RESULTS. With a 34 % higher cost of endoscopic hernioplasty compared to the operation using the Lichtenstein method, the effectiveness of TAPP was higher, which manifested itself in a more significant increase in the quality of life of patients in the postoperative period. The calculated cost-utility ratio also turned out to be 15 % higher with TAPP. Correlating the result of the incremental cost-utility analysis carried out below with the value of the «willingness to pay threshold» demonstrated the financial acceptability of TAPP. The value of the incremental indicator under TAPP not only did not exceed the «willingness to pay threshold», but was also 49 % lower than the value of GDP per capita.

CONCLUSION. The cost-utility analysis showed that regardless of cost fluctuations and changes in patients’ quality of life, the more expensive endoscopic TAPP intervention for inguinal hernia is economically justified, proving to be a profitable investment. 

1. Bittner R., Köckerling F., Fitzgibbons R. J., LeBlanc K. A. et al. Laparoendoscopic Hernia Surgery // Berlin Heidelberg: Springer-Verlag, 2018:475. Doi: 10.1007/978-3-662-55493-7_19.

2.

3. The Hernia Surge Group. International guidelines for groin hernia management. The Hernia Surge Group // Hernia. 2018;22(1):1–165. Doi:10.1007/s10029-017-1668-x.

4.

5. Köckerling F. What is the influence of simulation-based training courses, the learning curve, supervision, and surgeon volume on the outcome in hernia repair? A systematic review // Frontiers in Surgery. 2018;5:57– 67. Doi: 10.3389/fsurg.2018.00057.

6.

7. Clinical guidelines “Groin Hernia” (adults). Мoscow, Russian Society of Surgeons, 2021:28. (In Russ.).

8.

9. Abdominal Surgery. National Manual, Short Edition / eds by I. I. Zatevakhin, A. I. Kirienko, A. A. Kubyshkin. Мoscow, GEOTAR-Media, 2016:903. (In Russ.).

10.

11. Van Veenendaal N., Simons M., Hope W., Tumtavitikul S., Bonjer J. Hernia Surge Group. Consensus on international guidelines for management of groin hernias // Surg Endosc. 2020;34(6):2359–2377. Doi: 10.1007/ s00464-020-07516-5.

12.

13. Ielpo B., Nuñez-Alfonsel J., Duran H. et al. Cost-effectiveness of randomized study of laparoscopic versus open bilateral inguinal hernia repair // Ann Surg. 2018;268(5):725–730. Doi: 10.1097/SLA.0000000000002894.

14.

15. Matveev N. L., Belousov A. M., Bochkar V. A., Makarov S. A. Minimally invasive ventral hernia repair: apply or save? // Pirogov russian journal of surgery. 2020;8:75–81. (In Russ.). Doi: 10.17116/hirurgia202008175.

16.

17. Omelyanovsky V. V., Sisigina N. N., Fedyaeva V. K., Musina N. Z. Evolution of payment methods for medical care // Farmakoekonomika. Sovremennaya farmakoekonomika i farmako-epidemiologiya. 2019; 12(4):318–326. (In Russ.).

18.

19. Trukhalev V. A., Vlasov A. V., Kalinina А. A., Krivenkova E. M. Endoscopic Techniques in the Treatment of Inguinal Hernia // Journal of experimental and clinical surgery 2020;13(2):138–145. Doi: 10.18499/2070-478X- 2020-13-2-138-145.

20.

21. GOST R 57525-2017. Clinical and economic research. General requirements. Moscow, Standartinform, 2017:48. (In Russ.).

22.

23. Khabriev R. U., Kulikov A. Yu., Arinina E. E. Methodological foundations of pharmacoeconomic analysis. Moscow, Medicine, 2011:128. (In Russ.).

24.

25. Yagudina R. I., Kulikov A. Yu., Serpik V. G. Pharmacoeconomics. Rostovon- Don, Phoenix, 2017:237. (In Russ.).

26.

27. Makarova E. I., Yagudina R. I. Methodology for calculating QALYs in pharmacoeconomic modeling: the use of questionnaires for studying the quality of life of a patient // Pharmacoeconomics: theory and practice. 2018;6(1):7–11. (In Russ.).

28.

29. Darvin V. V., Poborsky A. N., Ponamarev N. I., Asutaev D. Parameters monitoring of quality of life in patients after inguinal herniorrhaphy // Vestnik SurGU. Medicina. 2019;2(40):57–62. (In Russ.).

30.

31. EQ-5D. URL: https//euroqol.org/ (accessed: 10.01.2020).

32.

33. Romashchenko P. L., Kurygin A. A., Semenov V. V., Polushin S. Yu., Mamoshin A. A., Zherebtsov E. S. Clinical and economic substantiation of endoscopic hernioplasty using the TAPP and TEР methods // Bulletin of the Russian Military Medical Academy. 2019;1(65): 125–128.

34.

35. Romashchenko P. L., Kurygin A. A., Semenov V. V., Mamoshin A. A. Endovideohernioplasty in patients with inguinal hernias: advantages and disadvantages // Bulletin of the Russian Military Medical Academy. 2021;3(75):93–100.

36.

37. Semenov V. V., Kurygin A. A., Romashchenko P. N., Tatyankin M. Yu., Yagin M. V. Endovideosurgical treatment of a patient with strangulated hernia Amianda // Bulletin of Surgery named I. I. Grekov. 2017; 176(2):112–114.