Robotic-assisted ventral hernia repair - a detailed economic evaluation: is it worth it?

Purpose: The use of robotic-assisted ventral hernia repair (rVHR) has expanded rapidly, but its economic viability remains debated. This study aimed to provide a transparent cost analysis of rVHR compared with open ventral hernia repair (oVHR), and to identify patient subgroups where rVHR may represent a cost-effective alternative. Methods: Patients with midline ventral hernias were randomized to rVHR or oVHR. A detailed bottom-up costing approach was applied, including preoperative, intraoperative, hospitalization, and post-hospitalization costs, as well as capital and maintenance costs of the robotic platform. Group-specific mean costs were estimated using log-linear regression models. Cost-consequence and cost-effectiveness analyses were performed, and an interaction model was used to explore cost differences in relation to hernia defect size. Results: Fifty-six patients were included (29 rVHR, 27 oVHR). Mean total hospital costs were significantly higher for rVHR (€3,539) compared with oVHR (€1,696; cost ratio 2.09, p <0.001). Instrumentation and consumables accounted for the largest share of rVHR costs, while hospitalization represented the largest component in oVHR. Modeling suggested a potential crossover point at a defect size of 56 cm², beyond which rVHR could become relatively more cost-effective. The cost-effectiveness analysis showed that robotic-assisted surgery required an additional €1,149 to reduce hospital stay by one day. Conclusion: Robotic-assisted ventral hernia repair is associated with substantially higher costs than open repair in our setting. However, rVHR may represent a more cost-effective strategy for larger or more complex hernias, supporting selective use based on patient characteristics and institutional resources.