A Cost-Comparison of Mesh Usage in Laparoscopic Paraesophageal Hernia Repair

Amareshewar Chiruvella, MD, Daniel Lomelin, MPH, Dmitry Oleynikov, MD. University of Nebraska Medical Center

INTRODUCTION : Use of absorbable mesh in paraesophageal hernia (PEH) repair has been shown in several studies to decrease recurrence rates in the short term.  Several biomaterials have been used, including Strattice™ and Alloderm®, which have shown to reduce hernia recurrence rates (15-20 %).  The introduction of an absorbable Bio-A® mesh (Gore®) in paraesophageal hernia repair has shown similar outcomes to Strattice™ and Alloderm®, increasing its utilization in crural reinforcement.  This study aims to compare costs of these three meshes in relation to the outcomes in terms of length of stay and recurrence, and determine whether cost difference should be a determining factor in the type of mesh used.

METHODS : We performed a retrospective analysis of patients from our institution who underwent PEH repair with mesh between December 2004 and June 2014.  Previously published analysis have shown that absorbable mesh has a lower radiologic recurrence rate than primary repair, but recurrence does increase with time in mesh repair patients.  However, symptom resolution is maintained in mesh patients, leading to its increased use for PEH repair.  For our analysis, we compared the cost of individual meshes and outcomes in terms of length of stay and recurrence at 1 year follow-up.  Statistics were calculated using IBM SPSS 20.0.0.0.

RESULTS :  227 patients underwent PEH repair with mesh.  Alloderm®   was used in 157, Strattice™ in 35 and Bio-A® in 35.  Patient groups were matched for confounding factors.  Recurrence rates and outcomes were similar in all groups.  Overall recurrence rate was 12%. No erosions or complications were observed with the use of any mesh.  No statistically significant difference was observed with the hospital length of stay.  Individual mesh costs were as follows: Strattice™ was $1202, Alloderm® was $783 and Bio-A® was $483.  The average operative costs were $7000 for Strattice™, $6400 for Alloderm®   and $5890 for Bio-A®.  65-70% of the cost difference between the three types of repairs was incurred by the cost of mesh alone, with the remainder attributable to the surgery itself.  

CONCLUSION :  Our study shows that while the outcomes of the three mesh groups were similar in a matched patient cohort, there was a significant difference in the mesh cost, increasing the overall operative cost.  While surgeon and hospital preference still plays a role in choosing the type of mesh used, knowledge of the individual mesh cost will help surgeons make more informed decisions in the future.