OBJECTIVES: The objective of this study was to compare the cost-effectiveness of open mesh versus open non mesh inguinal hernia repair in Brazil from private hospital and private payer perspectives. METHODS: Cost-effectiveness of open mesh vs open non mesh repair was modeled using a Markov model. Model was evaluated as a cohort simulation for a time horizon up to 15 years. Transition probabilities were derived from systematic review and other published sources. Resource utilization data were collected from two private hospitals and a private payer in Brazil. Utility values were extracted from published sources. Both costs and outcomes were discounted annually at 5%. RESULTS: Over both a five and fifteen year period, open mesh repair provides greater benefits in terms QALYs and fewer recurrences at a cumulatively higher cost than open non mesh repair procedures. Over a 5 and 15-year time frame, cost per one additional QALY is R$17,843 and R$2,991 respectively from a payer perspective and R$12,825 and R$957 respectively from a hospital perspective. Similarly, the cost per one recurrence avoided is 1162 R$ and R$245 in a five and fifteen years time horizon from payer perspective (R$836 and R$79 respectively from a hospital perspective). Results in the probabilistic sensitivity analysis were similar to deterministic analysis. In the five year perspective open mesh repair is more cost effective in comparison to open non mesh repair when the value for society's willingness to pay threshold for a QALY exceeds R$8000 for a life year (Zero R$ in the 15 years in both perspectives). CONCLUSIONS: Findings suggest that in Brazil, open mesh inguinal hernia repair is cost effective from both private hospitals and private payer perspectives and should be considered standard of care based on superior outcomes and costs.