Presentation Authors: Diboro Kanabolo*, Chicago, IL, Sangtae Park, Evanston, IL
Introduction: Long-term studies have shown that parastomal hernias (PH) occur in more than half of all stomas. Mesh prophylaxis has been shown to reduce PH after end-colostomy and ileal conduits. However, no cost-effectiveness studies on mesh prophylaxis have been performed for this population. Thus, our objective was to determine whether mesh prophylaxis to prevent PH is cost-effective in patients undergoing ileal conduit urinary diversion for bladder cancer.
Methods: We created a Markov model on the costs and effectiveness of mesh prophylaxis for patients undergoing radical cystectomy with a time horizon of 5 years. Costs were obtained from the literature and adjusted to 2018 US dollars. Effectiveness was measured in quality-adjusted life years (QALY). 1- and 2-way sensitivity analyses were performed to test the robustness of our model.
Results: In patients with stage I to IV bladder cancer, prophylactic mesh placement was a costlier, but more effective strategy compared with no mesh placement at index surgery. On average, incremental cost between the two strategies across all stages was $888.78 in favor of no mesh placement. Incremental effectiveness averaged 0.49 additional QALY across all stages. This resulted in an incremental cost-effectiveness ratio (ICER) of $1,814/QALY. The ICER increased with stage, from $1,418/QALY in Stage I to $3,497/QALY at Stage IV. With a willingness to pay of $50,000/QALY, mesh prophylaxis may be deemed cost-effective. On sensitivity analysis, the decision to place mesh was sensitive to the probability of mesh infection, whereas the cost of the mesh did not influence cost effectiveness.
Conclusions: In patients undergoing ileal conduit urinary diversion for bladder cancer, mesh prophylaxis at the time of radical cystectomy is a highly cost-effective strategy in preventing PH for patients presenting with all stages of bladder cancer.