Managing parastomal hernias: a cost-effectiveness analysis

Background: Approximately 30% of people with a stoma develop a parastomal hernia( Carne et al, 2003; Gray et al, 2005). These can be unsightly, uncomfortable, distressing or even life threatening. After surgical repair recurrence rates are high (46-100%) (Israelsson,2008) . A variety of support garments and belts have been designed to prevent or control parastomal hernias. The costs and benefits of various methods need to be understood by nurses helping patients to make stoma management decisions.
Purpose: Present a cost-effectiveness analysis related to:

• Having an untreated parastomal hernia
  
• Conservative means aimed at prevention or support of parastomal hernia
  
• Surgical correction of parastomal hernia
  

Methods: “Costs” includes financial and other costs, not limited to the patient. Costs are based on analysis of clinical notes, hospital and health fund documents and interviews with 15 subjects (5 with untreated parastomal hernias, 5 undertaking a preventive program and 5 who have undergone surgical repair).
Results:
Costs of having an untreated parastomal hernia may be psychological, social, physical, monetary and involve time. The only benefit is that it is technically easier for a surgeon to reverse a stoma with a hernia.
Costs of a conservative preventive/ support program  (Thompson and Trainor, 2005) include the cost of the garments and time to do the exercises. Benefits include decreased incidence of herniation, comfort and improved general health.
Costs of the surgical repair include money and time for hospitalization and recovery, risk of morbidity and of further herniation (Israelsson,2008). Benefits include improved comfort, morale, appliance adhesion and can be life saving if the parastomal hernia was incarcerated or strangulated.
Conclusions:
In most circumstances a conservative preventive/ support program is not only the cheapest in terms of money, it is more likely to enhance quality of life.