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Cost‐effectiveness of groin hernia repair from a randomized clinical trial comparing commercial versus low‐cost mesh in a low‐income country. BJS 2017; 104: 695-703.

Published: 16th February 2017

Authors: J. Löfgren, A. Matovu, A. Wladis, C. Ibingira, P. Nordin, E. Galiwango et al.


Over 200 million people worldwide live with groin hernia and 20 million are operated on each year. In resource‐scarce settings, the superior surgical technique using a synthetic mesh is not affordable. A low‐cost alternative is needed. The objective of this study was to calculate and compare costs and cost‐effectiveness of inguinal hernia mesh repair using a low‐cost versus a commercial mesh in a rural setting in Uganda.


This is a cost‐effectiveness analysis of a double‐blinded RCT comparing outcomes from groin hernia mesh repair using a low‐cost mesh and a commercially available mesh. Cost‐effectiveness was expressed in US dollars (with euros in parentheses, exchange rate 30 December 2016) per disability‐adjusted life‐year (DALY) averted and quality‐adjusted life‐year (QALY) gained.


The cost difference resulting from the choice of mesh was $124·7 (€118·1). In the low‐cost mesh group, the cost per DALY averted and QALY gained were $16·8 (€15·9) and $7·6 (€7·2) respectively. The corresponding costs were $58·2 (€55·1) and $33·3 (€31·5) in the commercial mesh group. A sensitivity analysis was undertaken including cost variations and different health outcome scenarios. The maximum costs per DALY averted and QALY gained were $148·4 (€140·5) and $84·7 (€80·2) respectively.


Repair using both meshes was highly cost‐effective in the study setting. A potential cost reduction of over $120 (nearly €120) per operation with use of the low‐cost mesh is important if the mesh technique is to be made available to the many millions of patients in countries with limited resources. Trial registration number: ISRCTN20596933 (http://www.controlled-trials.com).

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