Systematic literature review of cost-effectiveness analyses of robotic-assisted radical prostatectomy for localised prostate cancer

Abstract

ObjectivesReview and assess cost-effectiveness studies of robotic-assisted radical prostatectomy (RARP) for localised prostate cancer compared with open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP).DesignSystematic review.SettingPubMed, Embase, Scopus, International HTA database, the Centre for Reviews and Dissemination database and various HTA websites were searched (January 2005 to March 2021) to identify the eligible cost-effectiveness studies.ParticipantsCost-effectiveness, cost-utility, or cost-minimization analyses examining RARP versus ORP or LRP were included in this systematic review.InterventionsDifferent surgical approaches to treat localized prostate cancer: RARP compared with ORP and LRP.Primary and secondary outcome measuresA structured narrative synthesis was developed to summarize results of cost, effectiveness, and cost-effectiveness results (eg, incremental cost-effectiveness ratio [ICER]). Study quality was assessed using the Consensus on Health Economic Criteria Extended checklist. Application of medical device features were evaluated.ResultsTwelve studies met inclusion criteria, 11 of which were cost–utility analyses. Higher quality-adjusted life-years and higher costs were observed with RARP compared with ORP or LRP in 11 studies (91%). Among four studies comparing RARP with LRP, three reported RARP was dominant or cost-effective. Among ten studies comparing RARP with ORP, RARP was more cost-effective in five, not cost-effective in two, and inconclusive in three studies. Studies with longer time horizons tended to report favorable cost-effectiveness results for RARP. Nine studies (75%) were rated of moderate or good quality. Recommended medical device features were addressed to varying degrees within the literature as follows: capital investment included in most studies, dynamic pricing considered in about half, and learning curve and incremental innovation were poorly addressed.ConclusionsDespite study heterogeneity, RARP was more costly and effective compared with ORP and LRP in most studies and likely to be more cost-effective, particularly over a multiple year or lifetime time horizon. Further cost-effectiveness analyses for RARP that more thoroughly consider medical device features and use an appropriate time horizon are needed.PROSPERO registration numberCRD42021246811.

The Availability, Cost, Limitations, Learning Curve and Future of Robotic Systems in Urology and Prostate Cancer Surgery

“…The expenditures associated with the increased length of stay associated with RRP are a substantial contributor to the cost [ 57 ]. A systematic review investigating cost-effectiveness of RARP versus open and laparoscopic prostatectomy found RARP to be more costly but provided greater quality adjusted life years (QALY) and greater societal economic potential through more years spent working and associated taxation contributions, but the conclusion is somewhat limited by the heterogeneity of the studies included [ 58 ]. Interestingly, a recent cost-comparison of RARC in European countries identified that just 16% of the total cost was attributable to the robotic system and instruments with the operative duration and length of hospital stay being greater determinants of cost [ 59 ].…”

Global trends and prospects in health economics of robotic surgery: A bibliometric analysis

“…Some studies have suggested that robotic surgery can lead to lower complication rates, a better short-term quality of life, and better short-term postoperative functional recovery 14 . However, whether robotic surgery is more cost-effective than conventional surgeries remains controversial 15 , 16 . Moreover, the high cost, limited availability, and training opportunities are major obstacles to the adopting of robotic surgery 17 .…”