Robotic and Laparoscopic Gynaecological Surgery: A Prospective Multi-Centre Observational Cohort Study and Economic Evaluation in England.

Andrew McCarthy; Dilupa Samarakoon; Joanne Gray; Peter McMeekin; Stephen McCarthy; Claire Newton; Marrielle  Nobbenhuis; Jonathan  Lippiatt; Jeremy Twigg

doi:10.1136/bmjopen-2023-073990

Robotic and Laparoscopic Gynaecological Surgery: A Prospective Multi-Centre Observational Cohort Study and Economic Evaluation in England.

Andrew McCarthy^*, Dilupa Samarakoon, Joanne Gray, Peter McMeekin, Stephen McCarthy, Claire Newton, Marrielle Nobbenhuis, Jonathan Lippiatt, Jeremy Twigg

^*Corresponding author for this work

Nursing Midwifery and Health Department

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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 National Health Service (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 EuroQol-5 Dimension (EQ-5D-5L) utility, 6-minute walk test (6MWT), NHS costs using pounds sterling (£) 2018-2019 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 £1315) versus CLS and mean quality adjusted life year (QALY) difference of 0.0024 (95% CI -0.00051 to 0.0057), non-parametric incremental cost-effectiveness ratio of £231 667per QALY. For the adjusted cost-effectiveness analysis, RALS dominated CLS with a mean cost difference of -£188 (95% CI -£1321 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 randomised controlled trial 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
Article number	e073990
Number of pages	13
Journal	BMJ Open
Volume	13
Issue number	9
DOIs	https://doi.org/10.1136/bmjopen-2023-073990
Publication status	Published - 28 Sept 2023

Keywords

gynaecological oncology
health economics
minimally invasive surgery

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

@article{f9bd6bd14a094a339592d0e778117996,

title = "Robotic and Laparoscopic Gynaecological Surgery: A Prospective Multi-Centre Observational Cohort Study and Economic Evaluation in England.",

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 National Health Service (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 EuroQol-5 Dimension (EQ-5D-5L) utility, 6-minute walk test (6MWT), NHS costs using pounds sterling (£) 2018-2019 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 £1315) versus CLS and mean quality adjusted life year (QALY) difference of 0.0024 (95% CI -0.00051 to 0.0057), non-parametric incremental cost-effectiveness ratio of £231 667per QALY. For the adjusted cost-effectiveness analysis, RALS dominated CLS with a mean cost difference of -£188 (95% CI -£1321 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 randomised controlled trial 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.",

keywords = "gynaecological oncology, health economics, minimally invasive surgery",

author = "Andrew McCarthy and Dilupa Samarakoon and Joanne Gray and Peter McMeekin and Stephen McCarthy and Claire Newton and Marrielle Nobbenhuis and Jonathan Lippiatt and Jeremy Twigg",

note = "Funding information: The study was supported by Intuitive through a £93,850 funding grant and provision of a secure data management web service. Grant/award number: N/A. However, the study was managed and conducted by a wholly independent project team. The grant funding paid for identified project costs such as project management staff support, statistician and health economist support, equipment, supplies and hospital staff support. ",

year = "2023",

month = sep,

day = "28",

doi = "10.1136/bmjopen-2023-073990",

language = "English",

volume = "13",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ",

number = "9",

}

TY - JOUR

T1 - Robotic and Laparoscopic Gynaecological Surgery

T2 - A Prospective Multi-Centre Observational Cohort Study and Economic Evaluation in England.

AU - McCarthy, Andrew

AU - Samarakoon, Dilupa

AU - Gray, Joanne

AU - McMeekin, Peter

AU - McCarthy, Stephen

AU - Newton, Claire

AU - Nobbenhuis, Marrielle

AU - Lippiatt, Jonathan

AU - Twigg, Jeremy

N1 - Funding information: The study was supported by Intuitive through a £93,850 funding grant and provision of a secure data management web service. Grant/award number: N/A. However, the study was managed and conducted by a wholly independent project team. The grant funding paid for identified project costs such as project management staff support, statistician and health economist support, equipment, supplies and hospital staff support.

PY - 2023/9/28

Y1 - 2023/9/28

N2 - 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 National Health Service (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 EuroQol-5 Dimension (EQ-5D-5L) utility, 6-minute walk test (6MWT), NHS costs using pounds sterling (£) 2018-2019 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 £1315) versus CLS and mean quality adjusted life year (QALY) difference of 0.0024 (95% CI -0.00051 to 0.0057), non-parametric incremental cost-effectiveness ratio of £231 667per QALY. For the adjusted cost-effectiveness analysis, RALS dominated CLS with a mean cost difference of -£188 (95% CI -£1321 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 randomised controlled trial 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.

AB - 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 National Health Service (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 EuroQol-5 Dimension (EQ-5D-5L) utility, 6-minute walk test (6MWT), NHS costs using pounds sterling (£) 2018-2019 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 £1315) versus CLS and mean quality adjusted life year (QALY) difference of 0.0024 (95% CI -0.00051 to 0.0057), non-parametric incremental cost-effectiveness ratio of £231 667per QALY. For the adjusted cost-effectiveness analysis, RALS dominated CLS with a mean cost difference of -£188 (95% CI -£1321 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 randomised controlled trial 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.

KW - gynaecological oncology

KW - health economics

KW - minimally invasive surgery

UR - http://www.scopus.com/inward/record.url?scp=85173570136&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2023-073990

DO - 10.1136/bmjopen-2023-073990

M3 - Article

C2 - 37770262

SN - 2044-6055

VL - 13

JO - BMJ Open

JF - BMJ Open

IS - 9

M1 - e073990

ER -

Robotic and Laparoscopic Gynaecological Surgery: A Prospective Multi-Centre Observational Cohort Study and Economic Evaluation in England.

Abstract

Keywords

UN SDGs

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