Long-term cost-minimization analysis comparing laparoscopic with open (Lichtenstein) inguinal hernia repair

Abstract

Background: Laparoscopic surgery has emerged as a new treatment modality for inguinal hernia repair. The aim of the present study was to analyse its long-term costs in relation to those of open repair. Methods: A randomized multicentre study comparing totally extraperitoneal laparoscopic repair (TEP) with open repair by the Lichtenstein procedure was performed on men with a primary inguinal hernia. Long-term data on recurrences and complications up to 5 years after operation were collected. Taking treatment costs into consideration, a cost-minimization analysis was conducted. Results: A total of 1370 patients had an inguinal hernia repair, 665 in the TEP and 705 in the Lichtenstein group. The total hospital cost for the index operation was €710.6 higher for TEP repair (P < 0.001). Including costs associated with recurrences and complications, this difference increased to €795.1 (P < 0.001). Taking community costs into account, the difference decreased by €503.1 to €292.0 (P = 0.024). Conclusion: This cost-minimization analysis, including complications, reoperations and community costs during follow-up of 5 years, showed that laparoscopic inguinal hernia repair had a small but significant increase in overall costs compared with open repair. Copyright © 2010 British Journal of Surgery Society Ltd.