PSU19 ROBOTIC ASSISTED GASTRECTOMY COMPARED WITH OPEN RESECTION: A CASE-MATCHED STUDY OF CLINICAL OUTCOMES AND COST-EFFECTIVENESS

Abstract

In recent years, increasingly sophisticated tools have allowed for more complex robotic surgery. Robotic gastrectomy, however, is adopted in only a few selected centers. The goals of this study were to examine the adoption of robotic gastrectomy (RG) and to compare outcomes and costs between open and robotic gastric resections (OG). This is a case-matched analysis of patients who underwent robotic and open gastric resection performed at Sanchinarro University Hospital, Madrid from November 2011 to February 2017. 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). A sensitivity analysis was carried out in order to propagate the uncertainty of the estimations to the results of the model. We use a multivariate and stochastic sensitivity analysis performed by 5000 Monte Carlo simulations. The cost-effectiveness plane was used to represent all pairs of solutions of the model. Two groups of demographically similar patients were analyzed: the robotic group (n = 20) and the open surgery group (n = 20). The mean operative costs were higher for RG (€ 8471.99 versus €7300.95; p= 0.008); however, the mean overall costs were lower for RG (€15807.13 vs 20520.38€; p=0.771). Mean QALYs at 1 year for RG (0.744) was higher than that associated with OG (0.706). RG for locally advanced gastric carcinoma is safe, and long-term outcomes are comparable to those patients who underwent open resection. RG resulted in a shorter hospital stay, less blood loss and morbidity comparable with the outcomes of open gastrectomy, and is a cost-effective aproach.