Approximately 70,000 surgical inguinal hernia repairs are performed in England each year, at a cost to the NHS of £56 million a year. In the year 2001 to 2002, 95.9% of mesh repairs were performed by open surgery, and 4.1% of repairs were performed by laparoscopic surgery.
The anticipated costs of adopting laparoscopic surgery are based on the degree of diffusion of this technique. However, experts advised that, for the foreseeable future, it is unlikely that the uptake of laparoscopic surgery would exceed 40% of all surgical hernia repairs. If the annual percentage of laparoscopic repairs increased to 20%, the additional cost to the NHS in England would be approximately £1 million (based on the number and cost of hernia repairs in 2001 to 2002 of £1,078 for laparoscopic and £987 for open mesh repairs).
The cost effectiveness of laparoscopic surgery for inguinal hernia repair is influenced by:
the number of laparoscopic procedures performed per annum and the experience of the operating surgeon
the use of disposable or reusable laparoscopic equipment
the rates of hernia recurrence, serious complications and persistent pain (and its severity).
The duration of surgery is directly linked to the experience of the surgeon: the duration of laparoscopic surgery decreases as the operating surgeon's experience increases, and this should reduce the costs attributable to theatre time. Operating costs for open and laparoscopic repairs done by experienced surgeons are likely to be similar.
Hospital policy as to the use of reusable or disposable consumables will also have a significant impact on the cost of laparoscopic surgery. Reusable equipment for laparoscopic surgery costs about £170 per procedure compared with disposable equipment, which costs about £790 per procedure.
Regional variations in the implementation costs of this guidance are likely, depending on the degree to which laparoscopic surgery is taken up locally, and on variations in hospital policy towards, for example, the use of reusable or disposable equipment.