PMID- 34331840
OWN - NLM
STAT- MEDLINE
DCOM- 20220128
LR  - 20220317
IS  - 1463-1318 (Electronic)
IS  - 1462-8910 (Linking)
VI  - 23
IP  - 11
DP  - 2021 Nov
TI  - A semi-Markov model comparing the lifetime cost-effectiveness of mesh prophylaxis 
      to prevent parastomal hernia in patients undergoing end colostomy creation for 
      rectal cancer.
PG  - 2967-2979
LID - 10.1111/codi.15848 [doi]
AB  - AIM: 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  pound20,000/QALY, 
      the incremental NMBs (95% CI) ranged between  pound1,706 ( pound1,692 to  pound1,720) (stage I) 
      and  pound684 ( pound678 to  pound690) (stage IV) for synthetic versus no mesh, and  pound2,038 
      ( pound1,997 to  pound2,079) (stage I) and  pound1,671 ( pound1,653 to  pound1,689) (stage IV) for 
      synthetic versus biologic mesh. Synthetic mesh was more cost-effective than no 
      mesh unless the relative risk of PSH was >/=0.95 for stages I-III and >/=0.93 for 
      stage IV. [Correction added on 05 October 2021 after first online publication: 
      The estimation of health outcomes (QALYs) for all three interventions evaluated 
      (synthetic mesh; biologic mesh; no mesh) have been corrected in this version.] 
      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.
CI  - (c) 2021 The Association of Coloproctology of Great Britain and Ireland.
FAU - Mohiuddin, Syed
AU  - Mohiuddin S
AUID- ORCID: 0000-0003-4585-3392
AD  - Population Health Sciences, Bristol Medical School, University of Bristol, 
      Bristol, UK.
FAU - Reeves, Barnaby C
AU  - Reeves BC
AD  - Bristol Trials Centre (CTEU), Bristol Medical School, University of Bristol, 
      Bristol, UK.
FAU - Smart, Neil J
AU  - Smart NJ
AD  - Royal Devon & Exeter Hospital, Royal Devon & Exeter NHS Foundation Trust, Exeter, 
      UK.
FAU - Hollingworth, William
AU  - Hollingworth W
AD  - Population Health Sciences, Bristol Medical School, University of Bristol, 
      Bristol, UK.
CN  - CIPHER study group
LA  - eng
GR  - MR/K025643/1/MRC_/Medical Research Council/United Kingdom
GR  - 14/166/01/Health Technology Assessment Programme/
PT  - Journal Article
DEP - 20210812
PL  - England
TA  - Colorectal Dis
JT  - Colorectal disease : the official journal of the Association of Coloproctology of 
      Great Britain and Ireland
JID - 100883611
SB  - IM
MH  - Colostomy
MH  - Cost-Benefit Analysis
MH  - *Hernia, Ventral
MH  - Humans
MH  - *Rectal Neoplasms/surgery
MH  - Surgical Mesh
MH  - *Surgical Stomas/adverse effects
OTO - NOTNLM
OT  - Markov model
OT  - biologic mesh
OT  - cost-effectiveness
OT  - parastomal hernia
OT  - stoma
OT  - synthetic mesh
FIR - Blazeby, Jane
IR  - Blazeby J
FIR - Rogers, Chris
IR  - Rogers C
FIR - Pinkney, Thomas
IR  - Pinkney T
FIR - Blencowe, Natalie
IR  - Blencowe N
FIR - Callaway, Mark
IR  - Callaway M
FIR - Daniels, Ian
IR  - Daniels I
FIR - Gunning, Amanda
IR  - Gunning A
FIR - McNair, Angus
IR  - McNair A
FIR - Tabusa, Hana
IR  - Tabusa H
FIR - Murkin, Charlotte
IR  - Murkin C
EDAT- 2021/08/01 06:00
MHDA- 2022/01/29 06:00
CRDT- 2021/07/31 17:07
PHST- 2021/07/21 00:00 [revised]
PHST- 2021/06/17 00:00 [received]
PHST- 2021/07/26 00:00 [accepted]
PHST- 2021/08/01 06:00 [pubmed]
PHST- 2022/01/29 06:00 [medline]
PHST- 2021/07/31 17:07 [entrez]
AID - 10.1111/codi.15848 [doi]
PST - ppublish
SO  - Colorectal Dis. 2021 Nov;23(11):2967-2979. doi: 10.1111/codi.15848. Epub 2021 Aug 
      12.