OBJECTIVES: Despite the recent advantages in technolοgies used in complex abdominal wall hernia repair (CAWR), the incidence rate of post-operative complications remains high, resulting in increased morbidity and a significant economic burden. The objective of this study was to assess the budget impact of increasing the use of Poly-4-hydroxybutyrate (P4HB) mesh in CAWR, from the Greek public hospital and the third-party payer (EOPYY) perspective.

METHODS: An 18-month budget impact model was used to calculate the total cost for CAWR in the current and future world where an increased use of P4HB mesh takes place. The approaches used for CAWR in Greece were: P4HB mesh, synthetic mesh (flat, composite), biologic mesh and the no-mesh 2-step repair surgery. Data on epidemiology, market shares (MS), post-operative complications and resource use, at each approach, for Greece were obtained from 8 Greek surgeons (Expert panel). The current and future MSs of PH4B mesh were estimated at 7% and 25%, respectively. Two scenarios of future PH4B market uptake (15%, 37%) were explored. Direct medical costs of CAWR and associated complications were estimated. Unit costs were based on public official sources (€, 2018). The difference between the total cost in the current and future world reflects the budget impact.

RESULTS: The future use of PH4B mesh in 25% of CAWR cases was estimated to result in cost-savings of about €106,058 for the public hospital and €54,443 for EOPYY in the next 18 months. In the scenario where the MS of PH4B is 37%, the cost-savings were expected to reach €61,069 and €94,567 respectively, with the difference in trends between the two perspectives being driven by the cost of mesh.

CONCLUSIONS: An increase in the use of PH4B in CAWR would create financial savings both for public hospitals and EOPYY due to the significant reduction in the incidence of complications.