Hernia surgery offers value for money, finds study


A patient recovering from surgery

Hernia surgery may offer good value for money and improved quality of life for patients, according to a new analysis.

The government wants the NHS to make £20 billion worth of efficiency savings by 2015 and it has been suggested that money could be saved by performing fewer hernia operations. In a briefing by the Audit Commission in 2011, inguinal hernia repair surgery was included on a list of “low clinical value” treatments.

But the new study, published in the Journal of the Royal Society of Medicine, suggests that hernia surgery could be effective and also cost-effective based on patients’ own assessments of their health-related quality of life and the costs hospitals report they incur.

The research also suggests keyhole surgery may offer more health benefit and value for money than open surgery for hernia operations.

An inguinal hernia – the most common type – occurs when the bowel or fatty tissue in the abdomen pokes through the surrounding muscle wall into the groin. It can appear as a swelling in the groin and can be painful, but surgery is not normally required immediately. If the hernia is not operated on, there is a risk that a life-threatening complication known as strangulation can occur, which requires emergency surgery.

Since 2009, hospitals carrying out NHS-funded surgery on hernias, varicose veins, hip and knee replacements have been required to collect data from patients assessing their own health-related quality of life using questionnaires before and after their operations. These assessments, known as patient-reported outcome measures (PROMs), are designed to enable comparisons of the health benefits resulting from different treatments.

Researchers from Imperial College London and The King’s Fund used PROMs data to estimate the cost-effectiveness of open surgery and keyhole surgery for hernia repair. The results are expressed as a cost per quality-adjusted life year (QALY), a widely-used standard measure of treatment benefit.

The results show that hernia surgery appears cost-effective, with an average cost per QALY of £1,881. They also show that patients report greater health benefit after keyhole surgery than open surgery. The National Institute for Health and Clinical Excellence (NICE) normally recommends treatments costing up to £20,000 to £30,000 per QALY.

Sophie Coronini-Cronberg, from the School of Public Health at Imperial College London, who led the study, said: “Our results challenge the idea that hernia surgery has low clinical value. Based on what patients tell us about how the treatments help them, it would seem that hernia surgery not only improves people’s lives substantially but also represents good value for NHS spending.

“At present, PROMs are only being collected for a few procedures. We’ve shown that these reports can allow us to quantify the benefits that patients experience and also estimate the cost-effectiveness of treatments. If the government is serious about producing information on the health benefits of NHS services, then we need to collect more and properly make use of this kind of data.”

Professor John Appleby, Chief Economist at The King’s Fund and co-author of the study said: “The English NHS is at the forefront of collecting PROMs. This data will prove invaluable to clinicians, managers, researchers and others in analysing health outcomes so that services can be improved for patients.”

This analysis follows work at The King’s Fund by Professor Appleby and colleagues estimating the cost per QALY following hip replacement operations. This research is published by the Journal of the Royal Society of Medicine alongside the extension of the work to hernia operations.


‘Application of patient-reported outcome measures (PROMs) data to estimate cost-effectiveness of hernia surgery in England’ by Sophie Coronini-Cronberg et al. Journal of the Royal Society of Medicine, 2013.


Sam Wong

Sam Wong
School of Professional Development

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Email: press.office@imperial.ac.uk
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Surgery, Health-policy
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