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A Systematic Review of Economic Evaluations of the Use of Robotic Assisted Laparoscopy in Surgery Compared with Open or Laparoscopic Surgery

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Abstract

Background

Robot assisted laparoscopic (RAL) surgery developed to overcome the limitations of laparoscopy to assist in surgical procedures, has high capital and operating costs. Systematically assembled evidence demonstrating its clinical and cost effectiveness would be helpful for its adoption by decision makers.

Objective

To summarise the evidence on the cost-effectiveness of robot-assisted laparoscopic (RAL) surgery compared with relevant alternatives. Methods and results of identified studies were assessed to identify the deficiencies in evidence and areas for further research.

Methods

Studies reporting both costs and outcomes for comparisons of RAL with laparoscopy and/or open surgery were systematically identified. Searches were conducted in February 2015 on MEDLINE, EMBASE and NHS EED. Quality of the included studies was assessed against a standard checklist for economic analyses. Length of hospital stay and operating time (determinants of cost), cost of intervention, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were extracted. To aid comparison, costs were converted into a common currency and price year (2014 US dollars).

Results

Forty-seven eligible studies were identified (full economic evaluation n = 6 and cost analysis n = 41). Economic models were used in 11 (23 %) studies. Only three studies used a model considered representative of the disease and clinical pathway with a time-horizon allowing capture of relevant differences in outcomes across strategies. The cost of RAL varied substantially between uses, ranging from US$7011 for hysterectomy to over US$30,000 for radical cystectomy. The majority of estimates were between US$15,000 and US$25,000 per person. In part this difference is explained by the difference between studies in which costs were included. It was also identified to have higher costs than the alternatives it was compared against. Incremental cost per QALY for RAL radical prostatectomy was US$28,801–$31,763 over a 10-year period assuming 200 cases per annum.

Conclusion

The clinical evidence available for RAL overall and used within included studies is limited. RAL surgery costs were consistently higher than open and laparoscopic surgery. Therefore, in adopting the robotic technology decision makers need to take into account the cost effectiveness within their own systems. Economic models generated and published for radical prostatectomy and hysterectomy may be adapted to other health systems if the care pathway is similar to provide locally relevant data.

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Author contributions

Zafer Tandogdu: Review of articles, data extraction, and drafting of manuscript.

Luke Vale: critical appraisal, drafting of manuscript.

Cynthia Fraser: Library search terminology description, library searches.

Craig Ramsay: Corresponding author, critical appraisal.

Guarantor of overall content: Luke Vale.

Author information

Authors and Affiliations

  1. Northern Institute for Cancer Research, Newcastle University, Newcastle Upon Tyne, UK

    Zafer Tandogdu

  2. Health Economics Group, Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UK

    Zafer Tandogdu & Luke Vale

  3. Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD, UK

    Cynthia Fraser & Craig Ramsay

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  1. Zafer Tandogdu
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  2. Luke Vale
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Correspondence to Craig Ramsay.

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Study funding and conflict of interest

Zafer Tandogdu is with a European Association of Urology scholarship (EUSP clinical fellowship) at Newcastle University, Medical School, Northern Institute for Cancer Research (NICR), Newcastle upon Tyne, UK.

None of the authors have any conflicts of interest to declare.

No funding was granted for the independent work conducted.

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Tandogdu, Z., Vale, L., Fraser, C. et al. A Systematic Review of Economic Evaluations of the Use of Robotic Assisted Laparoscopy in Surgery Compared with Open or Laparoscopic Surgery. Appl Health Econ Health Policy 13, 457–467 (2015). https://doi.org/10.1007/s40258-015-0185-2

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