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dc.contributor.authorMohiuddin, S.
dc.contributor.authorReeves, B. C.
dc.contributor.authorSmart, N. J.
dc.contributor.authorHollingworth, W.
dc.identifier.citationColorectal Dis. 2021 Jul 31. doi: 10.1111/codi.15848.
dc.description.abstractAIM: Parastomal hernia (PSH) is a common problem following colostomy. Using prophylactic mesh during end colostomy creation may reduce PSH incidence, but concerns exist regarding the optimal type of mesh, potential long-term complications, and cost-effectiveness of its use. We evaluated the cost-effectiveness of mesh prophylaxis to prevent PSH in patients undergoing end colostomy creation for rectal cancer. METHODS: We developed a decision-analytical model, stratified by rectal cancer stages I-IV, to estimate the lifetime costs, quality-adjusted life-years (QALYs) and net monetary benefits (NMBs) of synthetic, biologic and no mesh from a UK NHS perspective. We pooled the mesh-related relative risks of PSH from 13 randomised controlled trials (RCTs) and superimposed these on the baseline (no mesh) risk from a population-based cohort. Uncertainty was assessed in sensitivity analyses. RESULTS: Synthetic mesh was less costly and more effective than biologic and no mesh to prevent PSH for all rectal cancer stages. At the willingness-to-pay threshold of £20,000/QALY, the incremental NMBs (95% CI) ranged between £3,412 (£3,384 to £3,439) (stage I) and £1,305 (£1,293 to £1,316) (stage IV) for synthetic versus no mesh, and £2,449 (£2,371 to £2,526) (stage I) and £1,784 (£1,753 to £1,815) (stage IV) for synthetic versus biologic mesh. Synthetic mesh was more cost-effective than no mesh unless the relative risk of PSH was ≥0.97 for stages I-III and ≥0.94 for stage IV. CONCLUSIONS: Synthetic mesh was the most cost-effective strategy to prevent the formation of PSH in patients after end colostomy for any rectal cancer stage; however, conclusions are dependent on which subset of RCTs are considered to provide the most robust evidence.
dc.rights© 2021 The Association of Coloproctology of Great Britain and Ireland.
dc.subjectbiologic mesh
dc.subjectmarkov model
dc.subjectparastomal hernia
dc.subjectsynthetic mesh
dc.titleA semi-Markov model comparing the lifetime cost-effectiveness of mesh prophylaxis to prevent parastomal hernia in patients undergoing end colostomy creation for rectal cancer
dc.typeJournal Article
dc.identifier.journalColorectal disease
dc.description.noteRD&E staff can access the full-text of this article by clicking on the 'Additional Link' above and logging in with NHS OpenAthens if prompted.
dc.description.admin-noteAccepted version (12 month embargo)

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