Background : Background This study evaluated the cost-effectiveness of open (OLR), laparoscopic (LLR), and robotic (RLR) liver resection.

Methods : Methods A comprehensive literature review and Bayesian network meta-analysis were conducted. Surface under cumulative ranking area values, mean difference (MD), odds ratio (OR), and 95% credible intervals (CrIs) were calculated for all outcomes. Cluster analysis was performed to determine the most cost-effective clustering approach. Costs-morbidity, costs-mortality, and costs-efficacy were the primary outcomes assessed, with postoperative overall morbidity, mortality, and length of stay (LOS) associated with total costs for OLR, LLR, and RLR.

Results : Results LLR incurred the lowest total costs (LLR versus OLR: MD -2529.84, 95% CrI -4192.69 to -884.83; LLR versus RLR: MD -3363.37, 95% CrI -5629.24 to -1119.38), while OLR had the lowest procedural costs (OLR versus LLR: MD -1185.91, 95% CrI -2224.58 to -142.29; OLR versus RLR: MD -3495.45, 95% CrI -5041.30 to -1946.64) but higher hospitalization costs than LLR (MD -3282.81, 95% CrI -4854.45 to -1906.29) and RLR (MD -3527.20, 95% CrI -5760.20 to -1367.50). RLR and LLR significantly reduced LOS than OLR and showed less postoperative morbidity. LLR resulted in the lowest readmission and liver-specific complication rates. LLR and RLR were superior in the costs-morbidity profile. RLR is less cost-effective regarding costs-mortality and costs-efficacy due to its highest total costs.

Conclusions : Conclusions LLR offers the most cost-effective option for hepatectomy with superior postoperative outcomes and shorter LOS compared to OLR. RLR, though costlier than LLR, along with LLR, consistently exceeds OLR in surgical performance