DISTRIBUTIONAL COST-EFFECTIVENESS ANALYSIS: A CASE STUDY OF VENTRAL HERNIAS IN ENGLAND AND THE ROLE OF TARGETED IMPLEMENTATION
Author(s)
Robert Malcolm, MSc1, Hayden Holmes, PGDIP1, Harriet Fewster, MSC1, Sam Woods, MSc1, Ellen Telfer-Thomas, BSc1, Laura Kelly, MSc1, Natalie Abraham, MSc2, Bev Halsey, MSc3, Sandra Van Guldener, MSc2, Gerhard Fidler, MSc2, Mark Cheetham, Dr4.
1York Health Economics Consortium, York, United Kingdom, 2BD, Winnersh, United Kingdom, 3Becton Dickinson, Winnersh, United Kingdom, 4Shrewsbury and Telford Hospital Trust, Shrewsbury, United Kingdom.
1York Health Economics Consortium, York, United Kingdom, 2BD, Winnersh, United Kingdom, 3Becton Dickinson, Winnersh, United Kingdom, 4Shrewsbury and Telford Hospital Trust, Shrewsbury, United Kingdom.
OBJECTIVES: It is estimated that 100,000 ventral hernia repairs are carried out each year in the UK. This is primarily driven by demographic changes such as increasing age and obesity, with over three quarters of reported risk factors associated with higher deprivation. Approximately 15-40% of people experience recurrence following a ventral hernia repair. This study aimed to understand the cost-effectiveness and health inequalities impact of bioabsorbable meshes, compared with uncoated synthetic and biologic meshes, in a general risk and at-risk population.
METHODS: An aggregate DCEA was conducted to estimate the impact of bioabsorbable surgical meshes on health inequalities in England, using Index of Multiple Deprivation (IMD) quintiles as the stratifying socioeconomic variable. Incremental costs and quality-adjusted life years (QALYs) were sourced from an economic analysis of different surgical meshes. Hospital Episode Statistics (HES) was used to source the prevalence of hernia recurrence. Opportunity cost was captured using a range of different scenarios, from £15,000 to £30,000 per QALY. Aggregate DCEA was conducted at a national level, as well as three different regions in England as a case study, reflecting variations in risk and deprivation.
RESULTS: Bioabsorbable meshes compared to biologic meshes were cost-effective and inequality improving across all scenarios, regions and subpopulations. Bioabsorbable meshes were cost-effective and inequality improving in the at-risk subgroup, when compared with uncoated synthetic meshes. Regional specific DCEA indicated much larger inequality improvements in areas where deprivation was higher, which is also associated with larger at-risk populations.
CONCLUSIONS: The analysis demonstrates that uncoated synthetic meshes are cost effective in lower risk populations, with bioabsorbable meshes being cost-effective in at risk populations. The optimal mesh choice will be driven by the patient risk. The analysis also demonstrates the role of targeted implementation to improve health inequalities, targeting the most appropriate mesh based on risk factors, which are associated with deprivation.
METHODS: An aggregate DCEA was conducted to estimate the impact of bioabsorbable surgical meshes on health inequalities in England, using Index of Multiple Deprivation (IMD) quintiles as the stratifying socioeconomic variable. Incremental costs and quality-adjusted life years (QALYs) were sourced from an economic analysis of different surgical meshes. Hospital Episode Statistics (HES) was used to source the prevalence of hernia recurrence. Opportunity cost was captured using a range of different scenarios, from £15,000 to £30,000 per QALY. Aggregate DCEA was conducted at a national level, as well as three different regions in England as a case study, reflecting variations in risk and deprivation.
RESULTS: Bioabsorbable meshes compared to biologic meshes were cost-effective and inequality improving across all scenarios, regions and subpopulations. Bioabsorbable meshes were cost-effective and inequality improving in the at-risk subgroup, when compared with uncoated synthetic meshes. Regional specific DCEA indicated much larger inequality improvements in areas where deprivation was higher, which is also associated with larger at-risk populations.
CONCLUSIONS: The analysis demonstrates that uncoated synthetic meshes are cost effective in lower risk populations, with bioabsorbable meshes being cost-effective in at risk populations. The optimal mesh choice will be driven by the patient risk. The analysis also demonstrates the role of targeted implementation to improve health inequalities, targeting the most appropriate mesh based on risk factors, which are associated with deprivation.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR228
Topic
Economic Evaluation, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
Gastrointestinal Disorders, Injury & Trauma