The progressive economic evaluation of a surgical technology : a case study of surgical repair of inguinal hernia
Methods: Different approaches to assessing the relative cost-effectiveness of the surgical techniques were considered: Systematic review of economic evaluation; A cost-consequence analysis; A cost-utility analysis; Incorporation of a discrete choice experiments (DCEs). Results: The data provided by the systematic review of economic evaluations were unreliable and unlikely to fully address the needs of decision-makers. However, using these data and data from a review of effectiveness, the National Institute for Clinical Excellence (NICE) concluded that laparoscopic repair of primary inguinal hernias was not worth the additional cost. A cost-consequence analysis was developed to make better use of the available data. It found that open non-mesh was not cost-effective and that a judgement is required about whether the benefits of laparoscopic repair (reduced pain and earlier return to usual activities) are worth the extra cost and the risk of rare, potentially serious intra-operative complications. The cost-utility analysis combined the effects of care into estimates of incremental cost per quality adjusted life year (QALY). The analysis suggested that laparoscopic repair was highly likely to be cost-effective. In 2004, NICE revised its guidance on inguinal hernia repair by recommending that laparoscopic repair was an acceptable method for use in the NHS. Conclusions: the progressive evaluation informed decision-makers about the role of laparoscopic repair. The systematic review of economic evaluations was of limited value but the three different forms of the economic evaluation drew attention to the choices and trade-offs that could be made.