Economic evaluation of robot‐assisted hysterectomy: a cost‐minimisation analysis

Abstract

Objective The aim of this study was to carry out an economic evaluation of robot-assisted hysterectomy compared with the current standard of care in Ireland.Design Cost-minimisation analysis of robot-assisted hysterectomy compared with a combination of traditional open and conventional laparoscopic surgery.Setting The publicly funded healthcare system in Ireland.Population The target population was women requiring hysterectomy that could be completed using robot-assisted surgery.Methods A simulation-based economic evaluation model including data derived from a systematic review and local databases was used to estimate surgical costs.Main outcome measures Incremental cost of robot-assisted surgery compared to current routine care.Results The incremental cost of robot-assisted hysterectomy is an estimated €3291 (95% confidence interval €2509-€4183) more than the existing mix of open and traditional laparoscopic surgery. The additional cost of robot-assisted surgery is primarily driven by the increased cost of surgical equipment, the robot, maintenance of the robot, and the cost of theatre staff due to longer operative times. The only significant factor reducing the cost of surgery is a shorter hospital stay relative to open surgery.Conclusions Robot-assisted hysterectomy is more costly than the current mix of open and traditional laparoscopic surgery. Without longer-term or functional outcome data, the additional expense associated with robot-assisted hysterectomy may not be justified in a budget-constrained health system.

A Systematic Review of Economic Evaluations of the Use of Robotic Assisted Laparoscopy in Surgery Compared with Open or Laparoscopic Surgery

“…Of these, full economic evaluation (i.e. cost-effectiveness, cost-minimisation, cost-utility, cost-benefit analysis) was performed in only six (13 %) [11][12][13][14][15][16]; the remaining articles reported cost analysis. Of note is that in many of these studies effectiveness data were also reported in the same article but these data were not interpreted along with the cost data as they would be in a full economic evaluation.…”

“…Of the 47 studies, 34 (72 %) were conducted in USA , two each in Switzerland (4 %) [51,52], Canada (4 %) [15,53], Ireland (4 %) [14,16] and Australia (4 %) [13,54], and one each in Denmark (2 %) [12], Italy (2 %) [55], Spain (2 %) [56], Sweden (2 %) [57] and the UK (2 %) [11].…”

“…Two (4 %) studies conducted their assessment from a societal perspective [12,19]. A perspective from a publicly funded healthcare system was taken in five (11 %) studies [11,[14][15][16]53]. …”

“…Clinical effectiveness data was gathered from multiple sources in 11 (23 %) studies [11, 14-17, 19, 20, 31, 34, 35, 53]. Of these, three studies used outcomes from meta-analysis that included both randomized controlled trials (RCTs) and non-randomised comparative studies measuring final clinical outcomes [11,16,53]. One (2 %) study gathered data from a prospective non-RCT single-centre study they carried out [13] and in one (2 %) study a RCT was conducted [39].…”

Economic evaluation of robot‐assisted hysterectomy: a cost‐minimisation analysis

“…1 The target population was clearly stated as women requiring hysterectomy that could be completed using robot-assisted surgery. Vaginal hysterectomies were therefore excluded from the analysis.…”