caa a22 4500 397576935 CHVBK 20180308164858.0 cr unu---uuuuu 161202e199603 xx s 000 0 eng 10.1093/oxfordjournals.pubmed.a024460 doi (NATIONALLICENCE)oxford-10.1093/oxfordjournals.pubmed.a024460 An economic evaluation of laparoscopic versus open inguinal hernia repair [Elektronische Daten] [Kate Lawrence, Douglas McWhinnie, Alex Goodwin, Alastair Gray, Joanna Gordon, John Storie, Julian Britton, Jack Collin] Background The rapid and widespread introduction of minimal access surgery has major implications for the National Health Service. It cannot be assumed that replacing an open procedure with a minimal access alternative will be cost-effective. Laparoscopic inguinal hernia repair is a procedure for which the potential economic benefits are particularly unclear. It is currently being adopted in many centres, although limited evidence on its clinical and cost-effectiveness exists. Methods This economic comparison of laparoscopic versus open hernia repair was undertaken on data collected on 104 patients undergoing surgery on a day case basis, in the context of a randomized controlled trial. Results The mean total health service cost of laparoscopic repair was £1074 versus £489 for open repair [mean difference in total health service costs £583; 95 per cent confidence interval (Cl) £265-£904]. This difference was largely accounted for by the difference in theatre costs. laparoscopic repair remained significantly more expensive for most but not all of the scenarios explored in the sensitivity analysis. The direction of the cost-effectiveness ratio was not sensitive to assumptions about long-term recurrence. Neither was it sensitive to halving the operating time in the laparoscopic arm of the trial. When both operating time and the costs of consumables were reduced, laparoscopic repair remained more expensive, but results for this scenario did not achieve statistical significance on this sample size. Conclusions Laparoscopic hernia repair appears an expensive option in most plausible situations. Furthermore, many uncertainties still exist about long-term outcome after the procedure and about the conditions necessary to maximize cost-effectiveness. Large-scale randomized studies to evaluate laparoscopic hernia repair are currently under way to address these issues. We suggest that further evidence is awaited before this technology is further diffused. © Oxford University Press Articles nationallicence inguinal hernia nationallicence laparoscopy nationallicence costs and cost nationallicence analysis nationallicence randomized controlled trial nationallicence Lawrence Kate Health Services Research Unit, Department of Public Health and Primary Care, Oxford University aut McWhinnie Douglas Department of Surgery, Milton Keynes Hospital aut Goodwin Alex Nuffield Department of Anaesthetics, Oxford University aut Gray Alastair Oxford Health Economics Group, Centre for Socio-Legal Studies, Oxford University aut Gordon Joanna Health Services Research Unit, Department of Public Health and Primary Care, Oxford University aut Storie John Nuffield Department of Anaesthetics, Oxford University aut Britton Julian Department of Surgery, John Radcliffe Hospital Oxford aut Collin Jack Nuffield Department of Surgery, Oxford University aut Journal of Public Health Oxford University Press 18/1(1996-03), 41-48 1741-3842 18:1<41 1996 18 pubmed https://doi.org/10.1093/oxfordjournals.pubmed.a024460 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1093/oxfordjournals.pubmed.a024460 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Lawrence Kate Health Services Research Unit, Department of Public Health and Primary Care, Oxford University aut NATIONALLICENCE 700 1- McWhinnie Douglas Department of Surgery, Milton Keynes Hospital aut NATIONALLICENCE 700 1- Goodwin Alex Nuffield Department of Anaesthetics, Oxford University aut NATIONALLICENCE 700 1- Gray Alastair Oxford Health Economics Group, Centre for Socio-Legal Studies, Oxford University aut NATIONALLICENCE 700 1- Gordon Joanna Health Services Research Unit, Department of Public Health and Primary Care, Oxford University aut NATIONALLICENCE 700 1- Storie John Nuffield Department of Anaesthetics, Oxford University aut NATIONALLICENCE 700 1- Britton Julian Department of Surgery, John Radcliffe Hospital Oxford aut NATIONALLICENCE 700 1- Collin Jack Nuffield Department of Surgery, Oxford University aut NATIONALLICENCE 773 0- Journal of Public Health Oxford University Press 18/1(1996-03), 41-48 1741-3842 18:1<41 1996 18 pubmed Metadata rights reserved CC BY-NC-4.0 http://creativecommons.org/licenses/by-nc/4.0 nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-oxford