Preventing incisional hernia after ileostomy closure: Budget impact analysis of prophylactic biosynthetic mesh use in Italy

BACKGROUND: Stoma-site incisional hernia is a frequent complication after stoma closure, causing morbidity and health care burden. Prophylactic mesh reinforcement, particularly with biosynthetic meshes, has shown promise in reducing these hernias without increasing the risk for infection. This study aimed to assess the budget effects of using biosynthetic mesh prophylactically during ileostomy closure for hernia prevention, from hospital, National Healthcare Service, and societal perspectives in the Italian health care context. METHODS: A budget impact model was developed over a 5-year time period to compare standard care (no mesh) with increasing adoption of prophylactic mesh (5-25%). Costs included hospital micro-costing data, national diagnosis-related group tariffs, and patient productivity losses. Clinical effectiveness referred to a prospective observational study showing a significant reduction in stoma-site incisional hernia incidence with mesh (8 vs. 24%, P = .029). RESULTS: From the hospital perspective, excluding costs that are common to both strategies for operating room and health care personnel, per-patient costs were 1,428.93€ with mesh and 2,290.00€ without mesh (saving 861.07€). Savings were also observed from the National Healthcare Service (179.84€ per patient) and societal (328.45€ per patient) perspectives. At a national level, considering 4,000 ileostomy closures per year, increasing mesh uptake to 25% projected cumulative savings of about €1.32 million (hospital), €0.44 million (National Healthcare Service), and €0.89 million (society). Scenario analysis confirmed consistency of savings across various European cost structures. CONCLUSIONS: Prophylactic biosynthetic mesh during stoma closure appears cost-saving, reducing stoma-site incisional hernia and reinterventions. Although long-term quality-of-life benefits remain uncertain, short-term outcomes support selective use in high-risk patients. Findings may inform health policy and future health technology assessment processes.