Cost-effectiveness of robot-assisted lobectomy compared with VATS lobectomy for early-stage lung cancer in the National Health Insurance Program of Korea.

Abstract

e16534 Background: Robotic surgery has proven to be one of the most effective cutting-edge technologies for successful minimally invasive surgery. This study aimed to evaluate the cost-effectiveness of robot-assisted lobectomy (RAL) for the treatment of early stage lung cancer with video-assisted thoracic surgery (VATS) lobectomy. Methods: From February 2009 to April 2011, one hundred twenty patients underwent RAL for clinical stage I or II non-small cell lung cancer. The consecutive 100 patients who underwent RAL were compared with 100 patients who underwent VATS lobectomy during the similar period under intent-to-treat analysis. Clinicopathologic characteristics and surgical outcomes were analyzed. Adverse events were defined as operative morbidities, mortality and conversion to open thoracotomy. The adverse events were adjusted by NCI-CTCAE 3.0 grade. Incremental cost-effective ratio (ICER) was defined as difference of total cost divided by difference of adjusted adverse events. Results: Tumor size was slightly larger in RAL group with 3.2cm in mean size of tumor. RAL needed longer operation time than VATS group. However, the console time during operation was similar with operation time in VATS lobectomy. The median length of postoperative stay was significantly shorter after robotic surgery than VATS. Operative morbidities developed in 9 patients in RAL and 21 in VATS (p=0.028). Conversions to thoracotomy were happened in 2 cases in RAL and 7 cases in VATS (p=0.170). The total hospital costs were higher in RAL than those in VATS ($14,186 vs. $11,509, p<0.001). ICER between RAL and VATS was $16,111 (80% CI; $9,190~$33,860) and NNT (numbers needed to treat) was 6.01. If six patients are treated by RAL, one case of adverse operative events could be diminished and its additional cost is $16,111. Conclusions: Robot-assisted lobectomy for early stage lung cancer is safe as well as feasible, and it results in a satisfying postoperative outcome compared with those after VATS lobectomy. Despite higher total costs, RAL is highly cost-effective to treat early stage lung cancer in National Health Insurance Program of Korea.