Page 103 - International guidelines for groin hernia management

Hernia

Chapter 24 Surgeons can only influence some of the factors above.
Operating time, surgical intervention quality, and instru-
ment and material choices are the surgeon’s responsibil-
Costs ity. 82–86 An individual surgeon’s experience and skill may
significantly impact cost when factors such as operating
G. H. van Ramshorst, R. Bittner, H. Eker and W. Hope time, complication rates and recurrences are
considered. 82, 85, 87
Introduction Studies report wide variations in quality of life and
Factors influencing costs in inguinal hernia repair. quality-adjusted life years (QALY) following IH repair. It
Cost calculations for IH repair are complex and difficult to is known for example, that patients receiving workers
perform. 77 Overall costs, including pretreatment, treatment compensation take longer to return to work than those not
and posttreatment medical care, societal and employer receiving these compensations. 79, 88 Patient-related factors
costs are rarely completely reported in studies. Moreover, it such as age, comorbidity, work type, employment history,
should be considered that costs are not equal to charges. 78 local culture, and physicians’ expectations influence
Charges are not necessarily related to costs, and are usually recovery time but their contribution to costs are difficult to
constructed using different formulas. Charges can vary evaluate. 89, 90 Additional costs such as medication expen-
greatly among hospitals and countries. Reimbursement of ses, home care compensations and transportation-related
costs by insurance companies or patients varies widely expenditures add to the tally and are similarly difficult to
between countries and hospitals, often depending on capture fully. Rarely considered are patient loss of income,
negotiations related to volume agreements. 79 All of the disability insurance costs, and costs associated with the
aforementioned stages in the treatment process are asso- patient’s inability to care for others. Other relevant
ciated with variable costs. employer-related outlays include: insurance costs, pro-
IH repair cost calculations are complex and difficult to ductivity losses and worker replacement costs. 79
perform. 77 Total costs, including pretreatment, treatment Complicating comparisons between studies on costs is
and posttreatment medical care, societal and employer the fact that currency conversions over time are problem-
costs are rarely reported completely. atic and in some studies only percentages of cost differ-
Data demonstrate clearly that hernia surgery cost cal- ences were estimated. In other studies percentages of
culations are determined by a large number of variables effectiveness differences were used to calculate incre-
including: mental cost per recurrence avoided and incremental cost
80
Patient-specific characteristics, hernia pathology, anes- per added day of work or usual activity.
thetic type, annual hernia case load, procedure type, sur- Laparoscopic repair costs can change over time as new
geons’ skills, fixation type (including no fixation), equipment is purchased, costs are spread over a higher
Complication frequency, operative setting, number of volume of procedures, or the equipment is used for other
postoperative visits, sick leave duration, recurrence rate, procedures. 91
salaries of personnel, equipment depreciation, share of KQ24.a Is open or endoscopic inguinal hernia repair more
costs from relevant support services. cost effective?
As expected, published data on costs of an IH operation KQ24.b What are the costs and cost differences between
show huge variations, ranging from about 126 USD to open and laparoscopic inguinal hernia repair?
more than 4116 USD. 80, 81 Even within one institution,
there are huge variations in costs generated by individual
providers. 81

123