Why does NICE not recommend laparoscopic herniorraphy?

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Abstract
Is NICE correct in its cost calculations? NICE has made it clear that the reasons for its choice have more to do with control of NHS costs than with clinical excellence. It calculated that the cost of an open repair was £412, whereas that of a laparoscopic repair was estimated to be £747. These calculations can be challenged on several grounds. Firstly, out of hospital costs were not included, so substantial reductions in social security and employers' costs after laparoscopic repair were ignored. Cost savings from reduced time off work have been estimated as £160-£400 in one study10 and up to £800 in another trial.11 Secondly, NICE erroneously assumed that the laparoscopic equipment (telescope, camera, light source, television monitor, etc) would be used only for hernia repair. In practice, of course, the equipment is also used for other laparoscopic procedures, particularly cholecystectomy. Although NICE showed that laparoscopic repair for recurrent or bilateral hernias offered clear cost savings over open repair, and better outcomes, it recommended that the procedure need only be “considered.” Also, NICE does not seem to have taken into account the potential for additional cost savings from intraoperative identification of occult contralateral hernias during laparoscopic repairs. About 25% of patients will need a second operation to repair a hernia in the contralateral groin. Many of these hernias would be identifiable at the time of the initial repair and could be treated with little additional cost.