OBJECTIVES: To evaluate the healthcare resource utilization and direct costs of inguinal hernia repair by real world data. METHODS:  This retrospective study based on the Chinese Basic Medical Insurance system in 2013. Target patients diagnosed with inguinal hernia and underwent inguinal hernia repair surgery were selected. Information of patient demographic characters, city tier, hospital tier, type of operation and cost were collected for the analysis. Descriptive statistics were used to describe patient demographic characters, healthcare resource utilization and direct medical cost. Direct medical cost include diagnostic tests, anesthesia, surgery, medical devices, drug and administration cost. Generalized linear regression model (GLM) was used to identify influence factors on the direct cost. RESULTS: Total 6,482 patients (74% adult; 86% male; mean age 44±27, 95% CI 1-82) were included. Mean (±SD) cost amounted to 8,121(±4,555; 95% CI 2,314-18,498) RMB, with 77.6% for operation related cost, 22.4% for drug. Factors significantly impacting inpatient cost were age, type of hernia (unilateral vs. bilateral), hospital tier, type of operation (open-mesh vs. laparoscopic), mesh using, type of insurance, gender (GLM, p<0.05). There were considerable differences of costs in these dimensions: age (adults 9,563 RMB vs. children 4,924 RMB), type of hernia (bilateral 10,284 RMB vs. unilateral 7,875 RMB), hospital tier (tier III 9,050 RMB, tier II 6,755 RMB and tier I 4,777 RMB), types of inpatient wards (Intra day ward 5,977 RMB vs. hospitalized ward 8,265RMB). CONCLUSIONS: The observed hospital cost for inguinal hernia repair was varied: a number of factors especially age, type of hernia and hospital tier had significant influence on inpatient cost. These influencing factors should be considered in policy making. Treatment in intra day ward showed more advantage than inpatient ward.