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

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Abstract
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 £1112·64, compared with £788·79 for the open operation. The extra cost of £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 £55 548·00 (95 per cent confidence interval £47 216·00–£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.