Abstract
Background
Robot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs.
Objective
To determine the cost-effectiveness of robotic prostatectomy.
Design, setting, and participants
We conducted a care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. We used data from a meta-analysis, other published literature, and costs from the UK National Health Service and commercial sources.
Outcome measurements and statistical analysis
Care received by men for 10 yr following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually.
Results and limitations
Over 10 yr, robotic prostatectomy was on average (95% confidence interval [CI]) £1412 (€1595) (£1304 [€1473] to £1516 [€1713]) more costly than laparoscopic prostatectomy but more effective with mean (95% CI) gain in quality-adjusted life-years (QALYs) of 0.08 (0.01–0.15). The incremental cost-effectiveness ratio (ICER) was £18 329 (€20 708) with an 80% probability that robotic prostatectomy was cost effective at a threshold of £30 000 (€33 894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy.
Conclusions
Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data.
Robot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs.
Objective
To determine the cost-effectiveness of robotic prostatectomy.
Design, setting, and participants
We conducted a care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. We used data from a meta-analysis, other published literature, and costs from the UK National Health Service and commercial sources.
Outcome measurements and statistical analysis
Care received by men for 10 yr following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually.
Results and limitations
Over 10 yr, robotic prostatectomy was on average (95% confidence interval [CI]) £1412 (€1595) (£1304 [€1473] to £1516 [€1713]) more costly than laparoscopic prostatectomy but more effective with mean (95% CI) gain in quality-adjusted life-years (QALYs) of 0.08 (0.01–0.15). The incremental cost-effectiveness ratio (ICER) was £18 329 (€20 708) with an 80% probability that robotic prostatectomy was cost effective at a threshold of £30 000 (€33 894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy.
Conclusions
Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data.
| Original language | English |
|---|---|
| Pages (from-to) | 361-369 |
| Number of pages | 9 |
| Journal | European Urology |
| Volume | 64 |
| Issue number | 3 |
| Early online date | 7 Mar 2013 |
| DOIs | |
| Publication status | Published - Sept 2013 |
Bibliographical note
Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.Keywords
- prostrate cancer
- robotic surgery
- laparascopic surgery
- cost-effectiveness analysis
Access to Document
- Close 2013
NOTICE: this is the author’s version of a work that was accepted for publication in European Urology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in EUROPEAN UROLOGY, [VOL 64, ISSUE 3, (2013)] DOI10.1016/j.eururo.2013.02.040
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Aberdeen research transforms national policy on the use of robots in prostate surgery
Craig Ramsay (Coordinator) & Clare Robertson (Participant)
Impact: Policy, Health and Wellbeing, Societal