Economic evaluation of different routes of surgery for the management of endometrial cancer: a retrospective cohort study

Abstract

ObjectivesThe benefits of minimally invasive surgery (MIS) for endometrial carcinoma (EC) are well established although the financial impact of robotic-assisted hysterectomy (RH) compared with laparoscopic hysterectomy (LH) is disputed.DesignRetrospective cohort study.SettingEnglish National Health Service hospitals 2011–2017/2018.Participants35 304 women having a hysterectomy for EC identified from Hospital Episode Statistics.Primary and secondary outcome measuresThe primary outcome was the association between route of surgery on cost at intervention, 30, 90 and 365 days for women undergoing an open hysterectomy (OH) or MIS (LH/RH) for EC in England. The average marginal effect was calculated to compare RH versus OH and RH versus LH which adjusted for any differences in the characteristics of the surgical approaches. Secondary outcomes were to analyse costing data for each surgical approach by age, Charlson Comorbidity Index (CCI) and hospital MIS rate classification.ResultsA total of 35 304 procedures were performed, 20 405 (57.8%) were MIS (LH: 18 604 and RH: 1801), 14 291 (40.5%) OH. Mean cost for LH was significantly less than RH, whereas RH was significantly less than OH at intervention, 30, 90 and 365 days (p<0.001). Over time, patients who underwent RH had increasing CCI scores and by the 2015/2016 year had a higher average CCI than LH. Comparing the cost of LH and RH against CCI score identified that the costs closely reflected the patients’ CCI. Increasing disparity was also seen between the MIS and OH costs with rising age. When exploring the association between provider volume, MIS rate and surgical costs, there was an association with the higher the MIS rate the lower the average cost.ConclusionsFurther research is needed to investigate costs in matched patient cohorts to determine the optimum surgical modality in different populations.

Robotic and laparoscopic gynaecological surgery: a prospective multicentre observational cohort study and economic evaluation in England

“…As they conducted a matched case control study, Sarlos et al 43 do not present adjusted costs. However, we argue that there are potential limitations in the matching used as no consideration is given to patient comorbidities, which have been identified as drivers of cost 44…”

Regional variations and deprivation are linked to poorer access to laparoscopic and robotic colorectal surgery: a national study in England

“…Studies demonstrate higher volume centres have lower readmission rates after MIS [ 27 , 31 ], with decreased costs [ 35 ]. NHS Scotland has invested £20 million to acquire 10 surgical robots nationally [ 36 ] and the Welsh Government has provided £4.2 million in funding (alongside £13.35 million from health boards) to create an ‘All-Wales Robotic Assisted Surgery Network’ [ 37 ].…”

Is robotic lobectomy cheaper? A micro-cost analysis

“…There are several limitations of this analysis. The preoperative clinical condition of the patient is not accounted for, and indeed in other specialties, such as gynaecology, it has been suggested that the higher cost of a robotic approach is influenced by the fact that patients undergoing robotic surgery tend to be more comorbid than patients undergoing laparoscopic surgery, and not just by the surgical approach alone [ 21 ]. Furthermore longer-term clinical and economic outcomes were not evaluated.…”