Comparative Cost-effectiveness of Robot-assisted and Standard Laparoscopic Prostatectomy as Alternatives to Open Radical Prostatectomy for Treatment of Men with Localised Prostate Cancer

A Health Technology Assessment from the Perspective of the UK National Health Service

Andrew Close, Clare Robertson, Stephen Rushton, Mark Shirley, Luke Vale, Craig Ramsay, Robert Pickard

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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.
Original languageEnglish
Pages (from-to)361-369
Number of pages9
JournalEuropean Urology
Volume64
Issue number3
Early online date7 Mar 2013
DOIs
Publication statusPublished - Sep 2013

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Biomedical Technology Assessment
National Health Programs
Prostatectomy
Cost-Benefit Analysis
Prostatic Neoplasms
Robotics
Costs and Cost Analysis
Therapeutics
Quality-Adjusted Life Years
Confidence Intervals
Uncertainty
Meta-Analysis
Quality of Life

Keywords

  • prostrate cancer
  • robotic surgery
  • laparascopic surgery
  • cost-effectiveness analysis

Cite this

@article{98b2998104774015a16f8cb018459b44,
title = "Comparative Cost-effectiveness of Robot-assisted and Standard Laparoscopic Prostatectomy as Alternatives to Open Radical Prostatectomy for Treatment of Men with Localised Prostate Cancer: A Health Technology Assessment from the Perspective of the UK National Health Service",
abstract = "BackgroundRobot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs.ObjectiveTo determine the cost-effectiveness of robotic prostatectomy.Design, setting, and participantsWe 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 analysisCare 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 limitationsOver 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.ConclusionsHigher 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.",
keywords = "prostrate cancer, robotic surgery, laparascopic surgery, cost-effectiveness analysis",
author = "Andrew Close and Clare Robertson and Stephen Rushton and Mark Shirley and Luke Vale and Craig Ramsay and Robert Pickard",
note = "Copyright {\circledC} 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.",
year = "2013",
month = "9",
doi = "10.1016/j.eururo.2013.02.040",
language = "English",
volume = "64",
pages = "361--369",
journal = "European Urology",
issn = "0302-2838",
publisher = "Elsevier",
number = "3",

}

TY - JOUR

T1 - Comparative Cost-effectiveness of Robot-assisted and Standard Laparoscopic Prostatectomy as Alternatives to Open Radical Prostatectomy for Treatment of Men with Localised Prostate Cancer

T2 - A Health Technology Assessment from the Perspective of the UK National Health Service

AU - Close, Andrew

AU - Robertson, Clare

AU - Rushton, Stephen

AU - Shirley, Mark

AU - Vale, Luke

AU - Ramsay, Craig

AU - Pickard, Robert

N1 - Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

PY - 2013/9

Y1 - 2013/9

N2 - BackgroundRobot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs.ObjectiveTo determine the cost-effectiveness of robotic prostatectomy.Design, setting, and participantsWe 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 analysisCare 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 limitationsOver 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.ConclusionsHigher 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.

AB - BackgroundRobot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs.ObjectiveTo determine the cost-effectiveness of robotic prostatectomy.Design, setting, and participantsWe 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 analysisCare 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 limitationsOver 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.ConclusionsHigher 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.

KW - prostrate cancer

KW - robotic surgery

KW - laparascopic surgery

KW - cost-effectiveness analysis

U2 - 10.1016/j.eururo.2013.02.040

DO - 10.1016/j.eururo.2013.02.040

M3 - Article

VL - 64

SP - 361

EP - 369

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 3

ER -