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A Cost-Effectiveness Evaluation of Surgical Approaches to Proctectomy

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Robotic surgery is increasingly used for proctectomy, but the cost-effectiveness of this approach is uncertain. Robotic surgery is considered more expensive than open or laparoscopic approaches, but in certain situations has been demonstrated to be cost-effective. We examined the cost-effectiveness of open, laparoscopic, and robotic approaches to proctectomy from societal and healthcare system perspectives.

Methods

We developed a decision-analytic model to evaluate one-year costs and outcomes of robotic, laparoscopic, and open proctectomy based on data from the available literature. The robustness of our results was tested with one-way and multi-way sensitivity analyses.

Results

Open proctectomy had increased cost and lower quality of life (QOL) compared with laparoscopy and robotic approaches. In the societal perspective, robotic proctectomy costs $497/case more than laparoscopy, with minimal QOL improvements, resulting in an incremental cost-effectiveness ratio (ICER) of $751,056 per quality-adjusted life year (QALY). In the healthcare sector perspective, robotic proctectomy resulted in $983/case more and an ICER of $1,485,139/QALY. One-way sensitivity analyses demonstrated factors influencing cost-effectiveness primarily pertained to the operative cost and the postoperative length of stay (LOS). In a probabilistic sensitivity analysis, the cost-effective approach to proctectomy was laparoscopic in 42% of cases, robotic in 39%, and open in 19% at a willingness-to-pay (WTP) of $100,000/QALY.

Conclusions

Laparoscopic and robotic proctectomy cost less and have higher QALY than the open approach. Based on current data, laparoscopy is the most cost-effective approach. Robotic proctectomy can be cost-effective if modest differences in costs or postoperative LOS can be achieved.

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Abbreviations

ICER:

Incremental cost-effectiveness ratio

LOS:

Length of stay

NSQIP:

National Surgical Quality Improvement Program

OR:

Operating room

QALY:

Quality-adjusted life year

QOL:

Quality of life

ROLARR:

The Robotic versus Laparoscopic Resection for Rectal Cancer Trial

SSI:

Surgical site infection

TaTME:

Trans-anal total mesorectal excision

WTP:

Willingness-to-pay

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Author information

Authors and Affiliations

  1. Department of Surgery, Virginia Mason Medical Center, Seattle, WA, USA

    Vlad V. Simianu

  2. Department of Surgery, Medical University of South Carolina, Charleston, SC, USA

    Thomas Curran

  3. Division of Colon and Rectal Surgery, University of Minnesota, Minneapolis, MN, USA

    Wolfgang B. Gaertner, Bradford Sklow, Robert D. Madoff & Christine C. Jensen

  4. Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA

    Karen M. Kuntz

  5. Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA

    Mary R. Kwaan

Authors
  1. Vlad V. Simianu
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Correspondence to Vlad V. Simianu.

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Disclosures

Drs. Simianu, Curran, and Gaertner have received travel, lodging, and education support from Intuitive Surgical. Dr. Madoff has received travel, lodging, and education support from Applied Medical. All available under review at: https://openpaymentsdata.cms.gov/.

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The current manuscript was a podium presentation at the American College of Surgeons Clinical Congress, October 29, 2019.

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Simianu, V.V., Curran, T., Gaertner, W.B. et al. A Cost-Effectiveness Evaluation of Surgical Approaches to Proctectomy. J Gastrointest Surg 25, 1512–1523 (2021). https://doi.org/10.1007/s11605-020-04615-5

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  • DOI: https://doi.org/10.1007/s11605-020-04615-5

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