Health economic analysis of total extraperitoneal repair versus Lichtenstein surgery for inguinal hernia: data from a randomized clinical trial

BACKGROUND: The aim was to compare cost-effectiveness of Lichtenstein under local anaesthesia (LLA) with total extraperitoneal repair (TEP) under general anaesthesia for primary inguinal hernia in men. An endoscopic approach to inguinal hernia repair is often considered costlier. The cost of endoscopic hernia repair, however, has not been compared to open inguinal hernia repair in a cost-effective setting. METHODS: Data from an RCT comparing TEP and Lichtenstein in a cost-effective setting, with health economy as a secondary endpoint, were used. Data on costs were collected prospectively. Data on sick leave were obtained from the Swedish Social Insurance Agency in order to compare lengths of sick leave. RESULTS: In total, 384 patients were included and 374 (97.4 per cent) patients were available for analysis, 189 in the LLA group and 185 in the TEP group. The median operating time for LLA was 70 (i.q.r. 60–80) min compared with 60 (i.q.r. 50–75) min in the TEP group (P < 0.001). The median time in operating theatre was 114 (i.q.r. 95–-125) min for LLA and 125 (i.q.r. 110–145) min for TEP (P < 0.001). The median cost including all materials was 2433 (i.q.r. 2084–2734) Euros for LLA and 2395 (i.q.r. 2093–2784) Euro for TEP (P = 0.650). Mean sick leave was 4.2 days in the LLA group and 6.2 days in the TEP group (P = 0.830). CONCLUSION: The overall cost to the hospital or length of sick leave did not differ between LLA and TEP.