Cost-utility analysis of the use of  prophylactic mesh augmentation compared with primary fascial suture repair in XXXX at high risk for  incisional @entity547 .

@entity1 @entity4438 @entity547 @entity2747 @entity4037
BACKGROUND: Although @entity547 repair with mesh can be successful, prophylactic mesh augmentation (PMA) represents a potentially useful preventative technique to mitigate incisional @entity547 risk in select high-risk @entity1 . The efficacy, cost-benefit, and societal value of such an intervention are not known. The aim of this study was to determine the cost-utility of using prophylactic mesh to augment @entity4438 . METHODS: A decision tree model was employed to evaluate the cost-utility of using PMA relative to @entity2747 ( @entity2747 ) after elective laparotomy. The authors adopted the societal perspective for cost and utility estimates. A systematic review of the literature on PMA was performed. The costs in this study included direct hospital costs and indirect costs to society, and utilities were obtained through a survey of 300 English-speaking members of the general public evaluating 14 health state scenarios relating to @entity4037 . RESULTS: @entity2747 without mesh demonstrated an expected average cost of  17,182 (average quality-adjusted life-year [QALY] of 21.17) compared with  15,450 (expected QALY was 21.21) for PMA. @entity2747 was associated with an incremental cost-efficacy ratio (ICER) of - 42,444/QALY compared with PMA such that PMA was more effective and less costly. Monte Carlo sensitivity analysis was performed demonstrating more simulations resulting in ICERs for @entity2747 above the willingness-to-pay threshold of  50,000/QALY, supporting the finding that PMA is superior. CONCLUSION: Cost-utility analysis of @entity2747 compared to PMA for abdominal laparotomy closure demonstrates PMA to be more effective, less costly, and overall more cost-effective than @entity2747 .
