A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy

Hohwü, Lena; Borre, Michael; Ehlers, Lars Holger; Pedersen, Katja Venborg

doi:10.3111/13696998.2011.586621

Cited by 46 publications

(68 citation statements)

References 15 publications

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“…Sensitivity analysis using the upper confidence limit for positive margin rate least favourable to robotic prostatectomy (0. 23) showed that robotic prostatectomy would be unlikely to be cost-effective. This value almost identical to that used for laparoscopic prostatectomy (0.24) and the difference (0.01) was lower than the central estimates from other comparative meta-analyses.…”

Section: Discussionmentioning

confidence: 99%

“…-A retrospective cohort study from Denmark compared costs and outcomes between robotic and open prostatectomy and found the robotic technique to be more costly but more effective with an ICER of €64,343 at one year. This was improved with a higher throughput of cases but cost-utility analysis reporting outcomes as QALYs was not performed [23]. A large cohort study from Sweden also indicated that for robotic prostatectomy case volume is linked to lower risks of positive margin and later biochemical recurrence [24].…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2013

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Background: Robot-assisted laparoscopic prostatectomy is increasingly used compared to a standard laparoscopic technique but it remains uncertain whether potential benefits offset higher costs.Objective: To determine cost-effectiveness of robotic prostatectomy.Design, Setting, Participants: 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. Data Sources:We used data from a meta-analysis, other published literature, and costs from United Kingdom (UK) National Health Service (NHS) and commercial sources.Outcome Measurements and Statistical Analysis: Care received by men for ten years 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 ten years robotic prostatectomy was on average [95% confidence interval] £1412 (€1595) [£1304 (€1473) to £1516 (€1713)] more costly than laparoscopic prostatectomybut more effective with mean (95% confidence interval) gain in quality adjusted life years (QALY) of 0.08 (0.01 to 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 more than 150 cases are performed each year.Considerable uncertainty persists in the absence of directly comparative randomised data.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…Three studies were in breast cancer (publication dates 1997 to 2003) (14)(15)(16), seven were in colorectal cancer (publication dates 2000 to 2011) (17)(18)(19)(20)(21)(22)(23) and seven were in prostate cancer (publication dates 2000 to 2012) (24)(25)(26)(27)(28)(29)(30). Two of the three breast cancer studies were set in the United States (14;16), and one was in Norway (15).…”

Section: Resultsmentioning

confidence: 99%

“…One study used the average weighted survival duration (42 months for resected patients) (22). One restricted costs and QALYs to the first post-operative year (25), while one used 5-year retrospective data without extrapolating either costs or benefits (16). Two studies, which limited the perspectives to that of single hospitals, presented incremental benefits over short horizons without extrapolating to account for downstream benefits or costs.…”

Section: Govindarajan 2006(19) Markov Modelmentioning

confidence: 99%

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Are Policy Decisions on Surgical Procedures Informed by Robust Economic Evidence? A Systematic Review

Ara¹,

Basarir

Keetharuth

et al. 2014

Int J Technol Assess Health Care

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Objectives: The aim of this study was to examine the empirical and methodological cost-effectiveness evidence of surgical interventions for breast, colorectal, or prostate cancer.Methods: A systematic search of seven databases including MEDLINE, EMBASE, and NHSEED, research registers, the NICE Web site and conference proceedings was conducted in April 2012. Study quality was assessed in terms of meeting essential, preferred and UK NICE specific requirements for economic evaluations.Results: The seventeen (breast = 3, colorectal = 7, prostate = 7) included studies covered a broad range of settings (nine European; eight non-European) and six were published over 10 years ago. The populations, interventions and comparators were generally well defined. Very few studies were informed by literature reviews and few used synthesized clinical evidence. Although the interventions had potential differential effects on recurrence and mortality rates, some studies used relatively short time horizons. Univariate sensitivity analyses were reported in all studies but less than a third characterized all uncertainty with a probabilistic sensitivity analysis. Although a third of studies incorporated patients’ health-related quality of life data, only four studies used social tariff values.Conclusions: There is a dearth of recent robust evidence describing the cost-effectiveness of surgical interventions in the management of breast, colorectal and prostate cancers. Many of the recent publications did not satisfy essential methodological requirements such as using clinical evidence informed by a systematic review and synthesis. Given the ratio of potential benefit and harms associated with cancer surgery and the volume of resources consumed by these, there is an urgent need to increase economic evaluations of these technologies.

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Cost-effectiveness of Robotic-Assisted Radical Prostatectomy for Localized Prostate Cancer in the UK

Labban

Song

Becker³

et al. 2022

JAMA Netw Open

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A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy

Abstract: RALP was more effective and more costly. A way to improve the cost effectiveness may be to perform RALP at fewer high volume urology centres and utilise the full potential of each robot.

Cited by 46 publications

References 15 publications

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

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

Are Policy Decisions on Surgical Procedures Informed by Robust Economic Evidence? A Systematic Review

Cost-effectiveness of Robotic-Assisted Radical Prostatectomy for Localized Prostate Cancer in the UK

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