Abstract
Objective
To compare the health related quality of life and cost effectiveness of robot-assisted laparoscopic surgery (RALS) versus conventional “straight stick” laparoscopic surgery (CLS) in women undergoing hysterectomy as part of their treatment for either suspected or proven gynaecological malignancy.
Design
Multicentre prospective observational cohort study.
Setting
Patients aged 16+ undergoing hysterectomy as part of their treatment for gynaecological malignancy at 12 NHS cancer units and centres in England between August 2017 and February 2020.
Participants
275 patients recruited with 159 RALS, 73 CLS eligible for analysis.
Outcome measures
Primary outcome was the European Organisation for Research and Treatment of Cancer Quality of Life measure (EORTC). Secondary outcomes included EQ-5D-5L utility, six-minute walk test (6MWT), NHS costs using pounds Sterling (£) 2018-19 prices and cost-effectiveness. The cost-effectiveness evaluation compared EQ-5D-5L quality adjusted life years and costs between RALS and CLS.
Results
No difference identified between RALS and CLS for EORTC, EQ-5D-5L utility, and 6MWT. RALS had unadjusted mean cost difference of £556 (95%CI -£314 to £1 315) versus CLS and mean quality adjusted life year (QALY) difference of 0.0024 (95%CI -0.00051 to 0.0057), non-parametric ICER of £152 843 per QALY. For the adjusted cost-effectiveness analysis, RALS dominated CLS with a mean
cost difference of £-188 (95%CI -£1 321 to £827) and QALY difference of 0.0024 (95%CI -0.0008 to 0.0057).
Conclusions
Findings suggest that RALS versus CLS in women undergoing hysterectomy (after adjusting for differences in morbidity) is cost effective with lower costs and QALYs. Results are highly sensitive to the usage of robotic hardware with higher usage increasing the probability of cost-effectiveness. Non-inferiority RCT would be of benefit to decision makers to provide further evidence on the cost-effectiveness of RALS versus CLS but may not be practical due to surgical preferences of surgeons and the extensive roll out of RALS.
To compare the health related quality of life and cost effectiveness of robot-assisted laparoscopic surgery (RALS) versus conventional “straight stick” laparoscopic surgery (CLS) in women undergoing hysterectomy as part of their treatment for either suspected or proven gynaecological malignancy.
Design
Multicentre prospective observational cohort study.
Setting
Patients aged 16+ undergoing hysterectomy as part of their treatment for gynaecological malignancy at 12 NHS cancer units and centres in England between August 2017 and February 2020.
Participants
275 patients recruited with 159 RALS, 73 CLS eligible for analysis.
Outcome measures
Primary outcome was the European Organisation for Research and Treatment of Cancer Quality of Life measure (EORTC). Secondary outcomes included EQ-5D-5L utility, six-minute walk test (6MWT), NHS costs using pounds Sterling (£) 2018-19 prices and cost-effectiveness. The cost-effectiveness evaluation compared EQ-5D-5L quality adjusted life years and costs between RALS and CLS.
Results
No difference identified between RALS and CLS for EORTC, EQ-5D-5L utility, and 6MWT. RALS had unadjusted mean cost difference of £556 (95%CI -£314 to £1 315) versus CLS and mean quality adjusted life year (QALY) difference of 0.0024 (95%CI -0.00051 to 0.0057), non-parametric ICER of £152 843 per QALY. For the adjusted cost-effectiveness analysis, RALS dominated CLS with a mean
cost difference of £-188 (95%CI -£1 321 to £827) and QALY difference of 0.0024 (95%CI -0.0008 to 0.0057).
Conclusions
Findings suggest that RALS versus CLS in women undergoing hysterectomy (after adjusting for differences in morbidity) is cost effective with lower costs and QALYs. Results are highly sensitive to the usage of robotic hardware with higher usage increasing the probability of cost-effectiveness. Non-inferiority RCT would be of benefit to decision makers to provide further evidence on the cost-effectiveness of RALS versus CLS but may not be practical due to surgical preferences of surgeons and the extensive roll out of RALS.
| Original language | English |
|---|---|
| Journal | BMJ Open |
| DOIs | |
| Publication status | Accepted/In press - 6 Sep 2023 |
