Robotic-assisted versus laparoscopic incisional hernia repair: differences in direct costs from a Brazilian public institute perspective

Background: This study aimed to compare the direct cost differences between robotic (RVIHR) and laparoscopic (LVIHR) hernia repair and determine each source of expenditure that may be related to the increased costs in a robotic program from the perspective of a Brazilian public institution. Methods The present study investigated the differences in direct costs from the data generated from a trial protocol (ReBEC: RBR-5s6mnrf). Patients with incisional hernia were randomly assigned to receive LVIHR or RVIHR. The direct medical costs of hernia treatment were described in the Brazilian currency (R$). Results Nineteen patients submitted to LVIHR were compared with eighteen submitted to RVIHR. The amount spent on operation room time (RVIHR: 2447,91 ± 644,79; LVIHR: 1989,67 ± 763,00; p  = 0,030), inhaled medical gases in operating room (RVIHR: 270,57 ± 211,51; LVIHR: 84,55 ± 252,34; p  = 0,023), human resources in operating room (RVIHR: 3164,43 ± 894,97; LVIHR: 2120,16 ± 663,78; p  < 0,001), material resources (RVIHR: 3204,32 ± 351,55; LVIHR: 736,51 ± 972,32; p  < 0,001), and medications (RVIHR: 823,40 ± 175,47; LVIHR: 288,50 ± 352,55; p  < 0,001) for RVIHR was higher than LVIHR, implying a higher total cost to RVIHR (RVIHR: 14712,24 ± 3520,82; LVIHR: 10295,95 ± 3453,59; p  < 0,001). No significant difference was noted in costs related to the hospital stay, human resources in ICU and ward, diagnostic tests, and meshes. Conclusion Robotic system adds a significant overall cost to traditional laparoscopic hernia repair. The cost of the medical and robotic devices plus longer operative times are the main factors driving the difference in costs.