Page 35 - Prevention and Treatment of Incisional Hernia- New Techniques and Materials

Economic evaluation
We will perform an ex-post economic evaluation in which a new suture technique using small bites is compared with the traditionally applied large bites technique, from a societal perspective. The economic evaluation will be performed in accordance with Dutch guidelines(37).
To measure the economic impact of the new suture technique using small bites the cost-e ectiveness will be assessed by calculating the incremental cost-e ectiveness ratio, de ned here as the di erence in average costs between both suture techniques divided by the di erence in average e ects. The primary outcome measure will be the costs per reduced incisional hernia within 1 year. Secondary, a cost-utility analysis will be performed using costs per quality adjusted life year (QALY) as outcome measure, using the EQ-5D.
Costs for all separate actions and time used by all individual health care professionals, and all other materials will be measured from a societal perspective for both bites techniques, which means that both direct medical costs (e.g. intervention costs, intramural and extramural medical costs) and indirect costs (absence from work, patient costs) will be included in the analysis.
For the most important cost items, unit prices will be determined by following the micro-costing method (Gold et al, 1996), which is based on a detailed inventory and measurement of all resources used. Resource costs arise within the hospital and consist of outpatient visits, inpatient days, use of the operation room, radiology examinations, blood tests, etc. Real medical costs will be calculated by multiplying the volumes of health care use with the corresponding unit prices. For instance, the calculation of the costs of both suture techniques will consist of detailed measurement of investments in manpower, equipment, materials, housing and overhead. The salary schemes of hospitals and other health care suppliers will be used to estimate costs per hour for each health care professional. Taxes, social securities and vacations will be included.
Data on e ects (reduction of incisional hernia), costs (time costs of new suture technique and material and development costs) and savings (reduced health care use of patients without incisional hernia) will all be collected in this study. Data on treatment (hospitalisation) and follow-up consultations will be collected retrospectively from (electronic) patient charts and hospital administration. This data will be collected by health care professionals using a data-collection form. Information will collected on:
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STITCH protocol
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