PUK4 Cost-Effectiveness of Robotic-Assisted Partial Nephrectomy

Abstract

To evaluate the cost-effectiveness of robotic-assisted partial nephrectomy (RAPN) compared to laparoscopic PN (LPN) and open procedure (OPN). A model combined decision tree and Markov model with a 10-year time horizon was developed to evaluate outcomes and costs for a hypothetical cohort of patients underwent partial nephrectomy for renal cell carcinoma. The decision tree was used to characterize the intraoperative infection, and the Markov model comprised four health states was used to estimate the expected survival duration and costs. Parameter estimates were derived from literature and claims data of the National Health Insurance in Taiwan. Univariate and probabilistic sensitivity analyses were conducted. The expected quality-adjusted life years (QALYs)/total costs for RAPN, LPN and OPN were 7.38/$12,548, 7.33/$8,587 and 6.60/$11,087, respectively. OPN was a dominated strategy as it provided fewer QALYs at increased cost compared with LPN. The incremental cost-effectiveness ratio for RAPN compared with LPN was $81,521 per QALY gained. Probabilistic sensitivity analysis indicated a 45% probability of RAPN being cost-effective at a hypothetical threshold of $75,000/QALY (3 times Taiwan‘s GDP per capita). This study shows that RAPN and LPN have similar outcomes, but RAPN has higher costs. There needs to be a decrease in costs of RAPN for the robot surgery to be cost effective.