OBJECTIVES: Rectus abdominal diastasis (RAD), which is defined as more than a 2 cm separation of the abdominal muscles, can cause mainly incontinence and lower-back pain. Despite its high incidence, there is no consensus on surgical indication. We aimed at performing a cost-effectiveness analysis from both National Healthcare Service (NHS) and societal perspectives in Italy to compare RAD repair (performed with minimally invasive technique with mesh implant) to no treatment (standard of care – SOC).

METHODS: A model was developed to project costs and quality-adjusted life years (QALYs) over a lifetime horizon for both RAD repair and SOC. Healthcare resource use, out-of-pocket costs and productivity losses were collected by the administration of an online socio-economic questionnaire, specifically developed, to 700 women with RAD. Quality of life data were obtained through the EuroQol 5D 5L. The rates of complications after RAD repair requiring procedural or surgical intervention were assessed from the analysis of the “Italian Hernia Club” registry.

RESULTS: Over a lifetime horizon, from the societal perspective, estimated costs were 74,520€ and 51,271€ for SOC and RAD repair, respectively, while QALYs were 18.82 and 24.78 for the two groups, thus showing that RAD repair may be a cost-saving strategy compared to SOC. Considering the NHS perspective, RAD repair showed a cost-effective profile with an ICUR of 831€ (additional cost per patient of 5,116€ compared to SOC).

CONCLUSIONS: In a context with paucity of economic evaluations for minimally invasive RAD repair, the present study provides relevant clinical and economic evidence to help improving the decision-making process and allocating scarce resources.