In a white paper about hernia mesh, analyst Winifred S. Hayes of Hayes Consulting helps one client figure out how to save money and be more efficient with their mesh purchases. The problem has been that in the case of hernia mesh, hospitals buy from a number of vendors and they end up paying top dollar.
With 18 different meshes used by this facility, and no particular reason why except an aggressive medical devices sales rep, Hayes applies her Evidence Based Value Analysis to figure which ones are the best fit for this medical facility.
Patients who have had their lives impacted by surgical mesh and its plastic properties, which can erode through organs, cause infection, and nerve entrapment, are forced to remove the mesh in risky surgery. The interesting part of the study is how many types of mesh Hayes couldn’t find enough good things to say about to merit their purchase.
This client was paying $1.1 million on surgical mesh of all kind, mostly polypropylene (334), animal based (46), polypropylene composites (101) and “others” (229) in the course of a year. Since polypropylene, a petroleum product, is cheaper it is used more often.
So what did she decide to eliminate?
Using the adverse event database within the U.S. Food and Drug Administration, she found:
*Infections, hematomas and seroma rates ranging from 3% to 61%
*Postoperative pain ranging from 3% to 20%
*Recurrence rates were less than 10%
*Five meshes were responsible for more than 20 adverse event reports in one year
Besides clinical trials, she found potential financial conflicts of interest and not enough credible evidence on 7 of 18 mesh brands to merit their continued use.
While Hayes does not name names, she recommends eliminating the high offenders from the client’s medicine chest, saving about $518,000 from the annual budget and reducing costs by about 50%.
There is no mention of the costs associated with the quality of life of someone implanted with a mesh that is eroding into the bowel or breaking into small pieces nor does she discuss the value of medical malpractice lawsuits saved by using the lesser of the offenders.
Among hernia meshes, the Kugel Composix Mesh Patch was recalled by the FDA in 2007 due to a ring break due to a defective product produced by Davol. But those who study polypropylene mesh have long understood that mesh is not inert and can continue to cause havoc inside the body for years.
It’s unfortunate that a medical facility looking to save money on hernia mesh doesn’t take the next step and follow-up with patients, one, two, five-years down the line to see how they are doing to get a real handle on the cost of living with mesh and its long-term consequences.