OBJECTIVES: The value of minimally invasive treatments for inguinal hernia need to appropriately balance quality of life and the costs associated with the intervention. The aim of this study is to compare clinical and cost-effective outcomes of the open Lichtenstein repair (OL) and laparoscopic trans-abdominal preperitoneal (TAPP) repair for bilateral inguinal hernias.

METHODS: This is a clinical and cost-effectiveness analysis within a randomized prospective study conducted at Sanchinarro University Hospital. Cases of primary, reducible bilateral inguinal hernia were included and randomized using a simple randomization program. Outcome parameters included surgical and post-operative costs, quality adjusted life years (QALY), and incremental cost per QALY gained or the incremental cost effectiveness ratio (ICER). A sensitivity analysis was carried out in order to propagate the uncertainty of the estimations to the results of the model. We use a multivariate and stochastic sensitivity analysis performed by 5000 Monte Carlo simulations. The cost-effectiveness plane was used to represent all pairs of solutions of the model.

RESULTS: Between March 2013 and January 2017, 165 patients were enrolled in this study (81 of them underwent TAPP and 84 OL). TAPP procedure had less early post-operative pain (p=0.037), a shorter length of stay (p=0.001) and less postoperative complications (p=0.002) when compared with the OL approach. TAPP procedure overall cost was higher compared with OL cost (1683.93€ vs 1192.83€, p=0.027). Mean QALYs at 1 year for TAPP (0.8094) was higher than that associated with OL (0.6765) (p=0.018). At a willingness-to-pay threshold of 20000 € and 30000 €, there was a 95.38% and 97.96% probability that TAPP was cost-effective relative to OL

CONCLUSIONS: TAPP procedure for bilateral inguinal hernia appears to be cost-effective compared with OL.