Economic benefits of robotic-assisted ventral hernia repair in India: an analysis of health utility, productivity, and operational gains from the real-world ASPIRE INDIA study

This study estimated the economic benefits of robotic-assisted ventral hernia repair (RVHR) using individual patient data (IPD) from a prospective multicenter study, the ASPIRE INDIA. The 30-day quality-adjusted life-years (QALY) gain was estimated from the EuroQol five-dimension three-level questionnaire scores (EQ-5D-3L), with uncertainty quantified via non-parametric bootstrap resampling. Productivity gains were estimated by wages drawn from a lognormal distribution fitted to Periodic Labour Force Survey (PLFS) 2023-24 data, adjusted to FY2026-27. A joint Monte Carlo (MC) simulation propagated uncertainty across all stochastic inputs. The results were scaled to an annual cohort of 300,000 cases. All assumptions were tested through sensitivity analyses. At 300,000 annual cases, the mean total benefit of RVHR over laparoscopic VHR (LVHR) was INR 2,799 million (95% confidence interval [CI]: INR 846-5,001) at 1x willingness-to-pay (WTP; INR 210,000/QALY) and INR 2,959 million (95% CI: INR 1,010-5,154 million) at 2x WTP. Post-anesthesia care unit (PACU) time saved represented the largest component of estimated economic benefit, which accounted for 65.8% of the total benefit at 1x WTP, followed by patient productivity (19.0%), caregiver productivity (9.5%), and QALY gain (5.7%). These findings identify the principal economic benefit dimensions for RVHR and provide a quantitative basis for structured value discussions at the institutional level regarding robotic-assisted surgery (RAS) adoption that should be considered alongside cost data in future comprehensive economic evaluations.