Cost-utility of robotic versus laparoscopic TAPP for inguinal hernia: a model‑based analysis from a public payer perspective.

backgroundRobotic transabdominal preperitoneal (r-TAPP) inguinal hernia repair is increasingly performed, but its economic value relative to laparoscopic TAPP (l-TAPP) remains uncertain, particularly in publicly funded health systems.

methodsA monthly state-transition (Markov) model was developed over a 24-month period from the perspective of the Italian National Health Service (SSN). A 90-day hospital/provider perspective was explored in scenario analyses. Costs were valued in 2023 euros, combining micro-costing data from a Spanish comparative study adjusted with OECD purchasing-power parities and Eurostat inflation indices, alongside Italian tariffs. Transition probabilities were derived from randomized trials and meta-analyses. Health-state utilities were obtained from EQ-5D studies in hernia populations and applied to model states. Deterministic one-way and probabilistic sensitivity analyses (10,000 iterations) were performed. Outcomes included incremental costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER), and probabilities of cost-effectiveness at willingness-to-pay thresholds of €20,000-30,000 per QALY.

resultsIn the SSN base case, r-TAPP generated an incremental cost of €2,224 and a gain of 0.05 QALYs versus l-TAPP, yielding an ICER of €44,480/QALY. At a €30,000/QALY threshold, the probability of cost-effectiveness was less than 25%. Scenario analyses incorporating Italian inputs or regional tariffs further reduced the cost-effectiveness. Exploratory model-based scenario analyses (bilateral repair, elevated BMI) also yielded ICERs ≥ €30,000/QALY, confirming limited probability of cost-effectiveness. Recurrence and reoperation rates were assumed equal between r-TAPP and l-TAPP, consistent with current evidence; however, potential differences over longer horizons could alter cost-effectiveness estimates.

conclusionsr-TAPP is associated with substantially higher costs and only marginal health gains compared with l-TAPP. The incremental QALY gain was small and not clinically meaningful, resulting in a probability of cost-effectiveness below 25% at a €30,000/QALY threshold. Routine adoption cannot be justified under current cost and reimbursement conditions, and its role should be confined to structured training programs or prospective research protocols.