Cost Effectiveness of Mesh Prophylaxis to Prevent Parastomal Hernia in Patients Undergoing Permanent Colostomy for Rectal Cancer Lawrence Lee, MD, MSc,

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Presentation transcript:

Cost Effectiveness of Mesh Prophylaxis to Prevent Parastomal Hernia in Patients Undergoing Permanent Colostomy for Rectal Cancer Lawrence Lee, MD, MSc, Abdulaziz Saleem, MD, MSc, Tara Landry, MLIS, Eric Latimer, PhD, Prosanto Chaudhury, MD, MSc, FACS, Liane S. Feldman, MD, FRCSC, FACS Journal of the American College of Surgeons Volume 218, Issue 1, Pages 82-91 (January 2014) DOI: 10.1016/j.jamcollsurg.2013.09.015 Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 1 Simplified schematic representing the decision between prophylactic mesh vs no mesh placement at the index operation. (A) Patients entering the model undergo abdominoperineal resection for rectal cancer. (B) If they survive, they enter into the cohort Markov model. APR, abdominoperineal resection; OR, operating room; PSH, parastomal hernia. Journal of the American College of Surgeons 2014 218, 82-91DOI: (10.1016/j.jamcollsurg.2013.09.015) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 2 Results of 2-way sensitivity analysis demonstrating the effect of co-varying the cost of the prophylactic mesh and probability of mesh infection in patients with stage I rectal cancer. $CAN, Canadian dollars. Journal of the American College of Surgeons 2014 218, 82-91DOI: (10.1016/j.jamcollsurg.2013.09.015) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 3 Plot of incremental costs and quality-adjusted life years (QALYs) of mesh prophylaxis vs no mesh. Each point represents the result of one simulation trial. $CAN, Canadian dollars. Journal of the American College of Surgeons 2014 218, 82-91DOI: (10.1016/j.jamcollsurg.2013.09.015) Copyright © 2014 American College of Surgeons Terms and Conditions

Figure 4 Cost-effectiveness acceptability curve of prophylactic mesh vs no mesh placement to prevent parastomal hernia, stratified by rectal cancer stage. (A) Including all studies listed in Table 1. (B) Excluding study by Lopez-Cano and colleagues.5 QALY, quality-adjusted life years. Journal of the American College of Surgeons 2014 218, 82-91DOI: (10.1016/j.jamcollsurg.2013.09.015) Copyright © 2014 American College of Surgeons Terms and Conditions