A cost effectiveness analysis of robotic versus laparoscopic distal pancreatectomy

Abstract

Background and Aims: The cost of robotic surgery represents a critical issue which has been investigated in only a few studies. There is no study in the literature which evaluates the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP).We have therefore performed a prospective comparative study of RDP and LDP at our centre with the aim of evaluating clinical and cost-effective outcomes. Material and Methods: This is an observational, comparative prospective non-randomized study which includes patients that underwent RDP and LDP reaching a minimum of 12 months of follow up from February 2014. Outcome parameters included surgical and post-operative costs, quality adjusted life years (QALY), and incremental cost per QALY gained, or the incremental cost effectiveness ratio (ICER). The primary end-point was to compare the cost effectiveness differences between both groups.A willingness-to-pay of 20,000 € and 30,000 € per QALY was used as a threshold to recognize which treatment was most cost-effective. Results: A total of 31 RDP and 28 LDP have been included. The overall mean total cost was similar in both groups (RDP: 9712.15 € versus LDP: 9424.68 €; P > 0.5). Mean QALYs at 1 year for RDP (0.652) was higher than that associated with LDP (0.59) (p>0.5). At a willingness-to-pay threshold of 20,000 € and 30,000 €, there was a 64.58% to 72.3% probability that RDP was cost-effective relative to LDP. Conclusion: This study provides data of cost-effectiveness between the RDP and LDP approaches showing a benefit for RDP.