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Robotic versus laparoscopic surgery for rectal cancer: a comparative cost-effectiveness study

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Abstract

Background

The differences between the costs of robotic rectal resection and of the laparoscopic approach are still not well known. The aim of this study was to evaluate the cost-effectiveness of robotic versus laparoscopic surgery.

Methods

We conducted an observational, comparative, prospective, non-randomized study on patients having laparoscopic and robotic rectal resection between February 2014 and March 2018 at the Sanchinarro University Hospital, Madrid. 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 endpoint was to compare cost effectiveness in the robotic and laparoscopic surgery groups. A willingness-to-pay of 20,000€ and 30,000€ per QALY was used as a threshold to determine the most cost-effective treatment.

Results

A total of 81 RRR and 104 LRR were included. The mean operative costs were higher for RRR (4307.09€ versus 3834.58€; p = 0.04), although mean overall costs were similar (7272.03€ for RRR and 6968.63€ for the LLR; p = 0.44). Mean QALYs at 1 year for the RRR group (0.8482) was higher than that associated with LRR (0.6532) (p = 0.018). At a willingness-to-pay threshold of 20,000€ and 30,000€ there was a 95.54% and 97.18% probability, respectively, that RRR was more cost-effective than LRR.

Conclusions

Our data regarding the cost-effectiveness of RRR versus LRR shows a benefit for RRR.

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Author information

Author notes

  1. Y. Quijano and J. Nuñez-Alfonsel contributed equally to this manuscript.

Authors and Affiliations

  1. Department of General Surgery, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain

    Y. Quijano, V. Ferri, R. Caruso, H. Durán, E. Díaz, L. Malavé, I. Fabra, E. Pinna, R. Isernia & E. Vicente

  2. Instituto de Validación de La Eficiencia Clínica (IVEc), Fundación de Investigación HM Hospitales, Madrid, Spain

    J. Nuñez-Alfonsel

  3. Department of General Surgery, Hospital HM Regla, HM Hospitales, León, Spain

    B. Ielpo

  4. Department of Economic Analysis and Finances, University of Castilla-La Mancha, Toledo, Spain

    Á. Hidalgo

Authors
  1. Y. Quijano
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  2. J. Nuñez-Alfonsel
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  8. L. Malavé
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Contributions

YQC wrote the manuscript and is responsible for its integrity. JN-A conceived and designed the analysis, performed the computer simulations and performed statistical analysis. BI collaborated in the analysis and interpretation of data and contributed to the writing of this article. HD, ED, LM and IF collected data and contributed to the acquisition and interpretation of data of the article. RC, VF, EP and RI collaborated in the analysis and interpretation of data. YQC and EVL drafted and critically revised the manuscript. ÁH-V participated in the conception and design of the analysis, and approved the version to be published.

Corresponding author

Correspondence to J. Nuñez-Alfonsel.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendment or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Quijano, Y., Nuñez-Alfonsel, J., Ielpo, B. et al. Robotic versus laparoscopic surgery for rectal cancer: a comparative cost-effectiveness study. Tech Coloproctol 24, 247–254 (2020). https://doi.org/10.1007/s10151-020-02151-7

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  • DOI: https://doi.org/10.1007/s10151-020-02151-7

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