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      Costs of inguinal hernia repair associated with using different medical devices in the Czech Republic

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          Abstract

          Objective

          Inguinal hernia repair is one of the most frequently carried out operations worldwide. The purpose of this article is to analyze the costs of hernia repair and to specify the loss or profit made under the conditions in the Czech Republic with respect to the currently used medical devices and approaches.

          Methods

          This article is based on the Drummond and O’Brien methodology, which specifically determines the content of direct and indirect costs in health services. The costs of operations during the period 2010–2014 were specified for a total of 746 patients. The cost details are described for four patients who represent the use of different types of medical devices. The procedure was a laparoscopic surgery in all cases.

          Results

          The total costs of inguinal hernia repairs (as per 2015 currency conversion rate) are €1,248,579; only part is covered from public funds, resulting in a loss of €218,359 for the hospital. The obtained data indicate that this operation is unprofitable for hospitals under the present conditions. The loss in the subject facility amounts to 17% of the total cost, which is the cost incurred by the hospital in the Czech Republic.

          Conclusion

          The study conducted in the Czech Republic refers to different economic results when using various medical device types. So the medical device selection depends on advantages or disadvantages for the patients, as well as on the cost effectiveness for the hospital.

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          Most cited references 14

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          Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair.

          The aim was to conduct a meta-analysis of the randomized evidence to determine the relative merits of laparoscopic (LIHR) and open (OIHR) inguinal hernia repair. A search of the Medline, Embase, Science Citation Index, Current Contents and PubMed databases identified all randomized clinical trials that compared OIHR and LIHR and were published in the English language between January 1990 and the end of October 2000. The meta-analysis was prepared in accordance with the Quality of Reporting of Meta-analyses (QUOROM) statement. The six outcome variables analysed were operating time, time to discharge from hospital, return to normal activity and return to work, postoperative complications and recurrence rate. Random effects meta-analyses were performed using odds ratios and weighted mean differences. Twenty-nine trials were considered suitable for meta-analysis. Some 3017 hernias were repaired laparoscopically and 2972 hernias were repaired using an open method in 5588 patients. For four of the six outcomes the summary point estimates favoured LIHR over OIHR; there was a significant reduction of 38 per cent in the relative odds of postoperative complications (odds ratio 0.62 (95 per cent confidence interval (c.i.) 0.46 to 0.84); P = 0.002), 4.73 (95 per cent c.i. 3.51 to 5.96) days in time to return to normal activity (P < 0.001), 6.96 (95 per cent c.i. 5.34 to 8.58) days in time to return to work (P < 0.001) and 3.43 (95 per cent c.i. 0.35 to 6.50) h in time to discharge from hospital (P = 0.029). There was a significant increase of 15.20 (95 per cent c.i. 7.78 to 22.63) min in the mean operating time for LIHR (P < 0.001). The relative odds of short-term recurrence were increased by 50 per cent for LIHR compared with OIHR, although this result was not statistically significant (odds ratio 1.51 (95 per cent c.i. 0.81 to 2.79); P = 0.194). LIHR was associated with earlier discharge from hospital, quicker return to normal activity and work, and significantly fewer postoperative complications than OIHR. However, the operating time was significantly longer and there was a trend towards an increase in the relative odds of recurrence after laparoscopic repair. Copyright 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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            Inguinal hernias.

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              Laparoscopic inguinal hernia repair.

              The safest and most effective inguinal hernia repair (laparoscopic versus open mesh) is being debated. As the authors point out, the former accounts for the minority of hernia repairs performed in the United States and around the world. The reasons for this are a demonstration in the literature of increased operative times, increased costs, and a longer learning curve. But the laparoscopic approach has clear advantages, including less acute and chronic postoperative pain, shorter convalescence, and earlier return to work. This article describes the transabdominal preperitoneal and totally extraperitoneal techniques, provides indications and contraindications for laparoscopic repair, discusses the advantages and disadvantages of each technique, and provides an overview of the literature comparing tension-free open and laparoscopic inguinal hernia repair.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2016
                26 October 2016
                : 12
                : 1593-1597
                Affiliations
                [1 ]Department of Economics, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove
                [2 ]Department of Surgical Studies, Faculty of Medicine, University of Ostrava, Ostrava
                [3 ]Center of Basic and Applied Research, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Kralove, Czech Republic
                Author notes
                Correspondence: Kamil Kuca, Center of Basic and Applied Research, Faculty of Informatics and Management, University of Hradec Kralove, Rokitanského 62, 50003, Hradec Kralove, Czech Republic, Email kamil.kuca@ 123456uhk.cz
                Article
                tcrm-12-1593
                10.2147/TCRM.S112353
                5087753
                © 2016 Marešová et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                medical device, czech republic, cost, hernia, laparoscopy

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