OBJECTIVES: Despite advances in surgical technique and prosthetic technologies, the risks for recurrence and infection are high following the repair of incisional ventral hernias. The current standard for reinforced hernia repair is synthetic mesh, which may reduce the risk for recurrence in many patients. Patients with comorbidities, contaminated wounds or previous wound infections experience higher rates of surgical site occurrences/infections (SSO/SSI). Mesh choice in Complex Abdominal Wall Repair (CAWR) may have an impact on short and long-term patient outcomes. The aim of this study was to analyze the economic consequences of P4HB Mesh use versus Permanent Synthetic Meshes in CAWR, under the perspective of the Austrian, German, UK, Spanish and Swiss National Health Systems. METHODS: A dynamic excel-based decision-analytic model was developed to assess the Budget Impact of P4HB Mesh in Complex Abdominal Wall Repair. For each Synthetic Mesh comparator, variables on efficiency were set as Hernia Recurrence, Infected Mesh Explantation, Wound Infection and Seroma. The analysis covered an 18 month time horizon and assumed 100% use for each technology. Public databases, as well as published and grey literature were used to estimate model input data. In the base case, a price difference of +1,700€ for P4HB mesh was considered. A tornado analysis was conducted for verification. RESULTS: Compared to Permanent Synthetic meshes, use of P4HB mesh in CAWR resulted in cost savings of 1,596€/1,514€/1,476£/1,376€/2,408€ per procedure in Austria/Germany/UK/Spain/Switzerland, respectively. The sensitivity analysis showed robust results for P4HB mesh, even in the most complex scenarios. CONCLUSIONS: Compared to Permanent Synthetic meshes, use of P4HB mesh may lead to potential cost savings in CAWR. Further research is needed in order to better assess rates of clinical complications, as well as the appropriate patient groups where P4HB technology would be most beneficial for patients and health systems