Long term COST-minimization analysis of robot-assisted hysterectomy versus conventional laparoscopic hysterectomy

María A Martínez-Maestre,Nuria García-Agua,Pluvio J Coronado,Francisco Jódar-Sánchez,Lidia M Melero-Cortés,Antonio J García-Ruíz,Carmen González-Cejudo

doi:10.1186/s13561-019-0236-8

Abstract

BackgroundThe aim of this study is to carry out the economic evaluation, in term of a cost-minimization analysis that considers healthcare costs and indirect costs, of robot-assisted hysterectomy (RAH) compared with conventional laparoscopic hysterectomy (CLH) in female adults scheduled for total laparoscopic hysterectomy for benign conditions.MethodsCost-minimization analysis based on an analytic observational study of prospective cohorts with a five-year time horizon. Eligible participants were all female adults scheduled for total laparoscopic hysterectomy for benign conditions at tertiary hospital. The economic evaluation was conducted from a Spanish National Health Service and societal perspective, including healthcare costs and indirect costs. The costs are expressed in Euros from the year 2015.ResultsOne hundred sixty nine patients were analyzed, 68 in the RAH group and 101 in the CLH group. Average cost for the RAH group was €8982.42 compared to €8015.14 for the CLH group (incremental cost €967.27; p = 0.054). Healthcare cost is the most important component of total cost and represents 86.4% for the RAH group and 82.3% for the CLH group. The difference of €1169 (p = 0.01) in the average healthcare cost is mainly due to the cost of purchasing and maintaining the equipment (difference of €1206.39 in favor of RAH; p < 0.005). With regard to indirect costs, for patients in the RAH group the costs associated with loss of productivity were lower (difference of €203.42; p = 0.17), while the cost of trips to the hospital was higher (difference of €1.98; p = 0.66) in respect to CLH.ConclusionsOur findings reveal similar effectiveness between RAH and CLH, although CLH is the more efficient option from the point of view of an economic analysis based on cost-minimization.

Highlights

The aim of this study is to carry out the economic evaluation, in term of a cost-minimization analysis that considers healthcare costs and indirect costs, of robotassisted hysterectomy (RAH) compared with conventional laparoscopic hysterectomy (CLH) in female adults scheduled for total laparoscopic hysterectomy for benign conditions
Cumulative incidences of major complications related to the benign gynecological pathology requiring surgical intervention were 8.8% vs. 8.9% for the robot-assisted hysterectomy (RAH) and CLH groups respectively (RR = 0,99; 95% confidence interval (CI): 0.37 to 2.65)
With regard to indirect costs, for patients in the RAH group the costs associated with loss of productivity were lower while the cost of trips to the hospital was higher

Summary

Introduction

The aim of this study is to carry out the economic evaluation, in term of a cost-minimization analysis that considers healthcare costs and indirect costs, of robot-assisted hysterectomy (RAH) compared with conventional laparoscopic hysterectomy (CLH) in female adults scheduled for total laparoscopic hysterectomy for benign conditions. The stable, three-dimensional view, more range of motion and improved coordination facilitate to learn the operating technique, which has made this advanced laparoscopic surgical procedure accessible to surgeons who do not have advanced video-endoscopic training [1]. These are the main reasons why, since its introduction, robotic surgery has generated enormous public excitement and achieved an impressive market penetration.

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