Abstract
OBJECTIVES: To demonstrate potential uses of nationally collected patient-reported outcome measures (PROMs) data to estimate cost-effectiveness of hernia surgery. DESIGN: Cost-utility model populated with national PROMs, National Reference Cost and Hospital Episodes Statistics data. SETTING: Hospitals in England that provided elective inguinal hernia repair surgery for NHS patients between 1 April 2009 and 31 March 2010. PARTICIPANTS: Patients >18 years undergoing NHS-funded elective hernia surgery in English hospitals who completed PROMs questionnaires. MAIN OUTCOME MEASURES: Change in quality-adjusted life year (QALY) following surgery; cost per QALY of surgery by acute provider hospital; health gain and cost per QALY by surgery type received (laparoscopic or open hernia repair). RESULTS: The casemix-adjusted, discounted (at 3.5%) and degraded (over 25 years) mean change in QALYs following elective hernia repair surgery is 0.826 (95% CI, 0.793-0.859) compared to a counterfactual of no treatment. Patients undergoing laparoscopic surgery show a significantly greater gain in health-related quality of life (EQ-5D index change, 0.0915; 95% CI, 0.0850-0.0979) with an estimated gain of 0.923 QALYS (95% CI, 0.859-0.988) compared to those having open repair (EQ-5D index change, 0.0806; 95% CI, 0.0771-0.0841) at 0.817 QALYS (95% CI, 0.782-0.852). The average cost of hernia surgery in England is £1554, representing a mean cost per QALY of £1881. The mean cost of laparoscopic and open hernia surgery is equivocal (£1421 vs. £1426 respectively) but laparoscopies appear to offer higher cost-utility at £1540 per QALY, compared to £1746 per QALY for open surgery. CONCLUSIONS: Routine PROMs data derived from NHS patients could be usefully analyzed to estimate health outcomes and cost-effectiveness of interventions to inform decision-making. This analysis suggests elective hernia surgery offers value-for-money, and laparoscopic repair is more clinically effective and generates higher cost-utility than open surgery.