کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | ترجمه فارسی | نسخه تمام متن |
---|---|---|---|---|---|
4278178 | 1611482 | 2016 | 7 صفحه PDF | سفارش دهید | دانلود رایگان |
• Most male patients with asymptomatic inguinal hernia will require repair.
• Mathematical models suggest that early repair is less costly to payers than expectant management.
• Over a ten-year cycle of care, the net present value of money influences overall cost of care.
BackgroundExpectant management (EM) and early open repair (OR) are safe and effective as initial management strategies for minimally symptomatic inguinal hernia in male patients. Extended follow-up of patients in EM protocols have shown that most patients will eventually require repair, but it is not clear which strategy is less costly over the long term.MethodsWe constructed a mathematical model to compare 3rd-party payer expenditures for EM vs OR or laparoscopic repair in a simulated cohort of patients with inguinal hernia. Cohort characteristics and expenditures were calibrated to recent randomized trials that reported initial follow-up and expenditures at 2 years and long-term crossover rates from EM to OR.ResultsCost comparisons between OR and EM are sensitive to direct long-term costs of inpatient and outpatient care, the likelihood of crossover from EM to operation, cost differences between OR and laparoscopic repair, and the net present value of longer-term costs.ConclusionsOur findings suggest that short-term costs of EM are less than those of OR and Lap-R, but early OR provides the highest long-term savings.
Journal: The American Journal of Surgery - Volume 211, Issue 6, June 2016, Pages 975–981