This NIHR HTA-funded evidence synthesis assessed the clinical and cost effectiveness of open mesh repairs in adults presenting with a clinically diagnosed unilateral, primary inguinal hernia who are operated in an elective setting. The assessment was conducted to current methodological standards and focused on evidence from randomised controlled trials comparing the effects of open pre-peritoneal mesh repair versus Lichtenstein mesh repair with particular attention to postoperative chronic pain. A fully probabilistic economic model was developed to assess the cost-effectiveness of these open mesh procedures. Comprehensive sensitivity analyses were used to address uncertainty.

Although with some uncertainty, people who underwent the open preperitoneal repair returned to work and normal activities earlier than those who underwent the Lichtenstein repair. In general, the open preperitoneal repair was associated with fewer episodes of pain, fewer recurrences and fewer complications than the Lichtenstein repair. The open preperitoneal mesh repair showed to improve patient QoL through a reduction in chronic pain, early complications and recurrences and appeared to be the most cost-effective option. However, evidence on the long-term effects was limited and there was some uncertainty with regard to the parameters used to populate the economic model. Further research was suggested to determine the long-term clinical effectiveness as well as the most cost effective option of open mesh procedures for primary inguinal hernia.


Miriam Brazzelli; 




Sharma, P, Boyers, D, Scott, N, Hernandez, R, Fraser, C, Cruikshank, M, Ahmed, I, Ramsay, C, R., Brazzelli, M The clinical effectiveness and cost-effectiveness of open mesh repairs in adults presenting with a clinically diagnosed primary unilateral inguinal hernia who are operated in an elective setting: systematic review and economic evaluation. . Health Technol Assess 2015;19(92)

Boyers, D, Hernandez, R, Sharma, P, Scott, N, Fraser, C, Cruickshank, M, Ahmed, I, Ramsay, C, Brazzelli, M 'Primary inguinal hernia: changing open repair technique likely cost-effective. HERU Policy Briefing 2017