Value Analysis Of Methods Of Inguinal Hernia Repair
*Robert E Glasgow, Sean J Mulvihill, *Brigitte K Smith, *David R Ray, *Jeffrey T Young, Samuel RG Finlayson
University of Utah, Salt Lake City, UT
OBJECTIVE(S): Value is defined as health outcomes important to patients relative to cost of achieving those outcomes: Value=Quality/Cost. For inguinal hernia repair, Level 1 evidence shows no differences in long-term functional status or recurrence rates when comparing surgical approaches. Differences in value reside within differences in cost. The aim of this study was to compare the value of approaches to fixing an inguinal hernia: Open(OpenIH), Laparoscopic(L-TEP), Robotic(R-TAPP).
METHODS: Variable and fixed hospital costs were compared among consecutive OpenIH, L-TEP, and R-TAPP repairs (100 each). Variable costs (VC) including direct materials, labor and variable overhead ($/minute OR time) were evaluated using Value Driven Outcomes, an internal activity-based costing methodology. Variable and fixed costs were allocated using full absorption costing assuming fixed cost allocation to 100 cases per year for each approach. As cost data is proprietary, differences in cost were normalized to OpenIH cost.
RESULTS: Compared to OpenIH, VC for L-TEP were 1.06X higher (including a 0.84X reduction in cost for OR time). For R-TAPP, VC were 2.34X higher (including 1.6X increased costs for OR time). With allocation of fixed cost, a L-TEP was 1.08X more costly while R-TAPP was 5.3X more costly than OpenIH. Using recurrence as the quality metric in the value equation, L-TEP decreases value by 8% and R-TAPP by 81% compared to OpenIH.
CONCLUSIONS: Use of higher cost technology to repair inguinal hernias reduces value. Incremental health benefits must be realized to justify increased costs. We predict payors and patients will soon incorporate value into payment decisions.
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