OBJECTIVES: Fibrin sealants (FS) are used during surgical procedures to achieve hemostasis, as sealants and to adhere tissues or implants to tissue. Because of added costs FS are not used in every procedure that could benefit. This study compared the average costs of incisional hernia procedures with and without use of FS. METHODS: Spanish cost data were applied to results from a prospective, randomized controlled trial of sixty patients undergoing incisional hernia with dermolipectomy treated with FS (TISSEEL, Baxter Healthcare) or no FS (controls). Data obtained from the clinical study included: Use of FS, prophylactic antibiotics and antithrombotics, duration of hospital stay, postoperative morbidity, need for blood transfusions and hernia recurrence. The study compared the average cost per surgery in both groups, the incremental cost for FS and the average costs for treatment of adverse events (AE) attributed to the surgery. RESULTS: Based on reported resource use the average costs per incisional hernia case were calculated as €7,284 and €12,744 for surgeries with and without FS use, respectively. The major cost driver was differences in hospitalization length between the treatment arms. A sensitivity analysis that excluded hospitalization costs still found FS to be cost-saving. Significant differences in hematoma rates and blood transfusions increased the average costs per surgery by €1.77 and €43.20 in the control group, respectively. The cost of FS represented 2.5% of total costs in active treatment arm (€179 per surgery). These results are only applicable to Spain and countries with similar clinical outcomes and costs structures. Though, this model can easily be adapted as long as only the cost structure differs. CONCLUSIONS: The results suggest the costs of FS in incisional hernia may be offset by reduced ancillary surgical costs and shorter hospitalization periods. Future prospective randomized studies collecting more detailed resource use data are necessary to validate these findings.