Department of Urology, Aarhus University Hospital, Skejby, Aarhus, Denmark.
J Med Econ. 2011;14(4):403-9. doi: 10.3111/13696998.2011.586621. Epub 2011 May 23.
To evaluate cost effectiveness and cost utility comparing robot-assisted laparoscopic prostatectomy (RALP) versus retropubic radical prostatectomy (RRP).
In a retrospective cohort study a total of 231 men between the age of 50 and 69 years and with clinically localised prostate cancer underwent radical prostatectomy (RP) at the Department of Urology, Aarhus University Hospital, Skejby from 1 January 2004 to 31 December 2007, were included. The RALP and RRP patients were matched 1:2 on the basis of age and the D'Amico Risk Classification of Prostate Cancer; 77 RALP and 154 RRP. An economic evaluation was made to estimate direct costs of the first postoperative year and an incremental cost-effectiveness ratio (ICER) per successful surgical treatment and per quality-adjusted life-year (QALY). A successful RP was defined as: no residual cancer (PSA <0.2 ng/ml, preserved urinary continence and erectile function. A one-way sensitivity analysis was made to investigate the impact of changing one variable at a time.
The ICER per extra successful treatment was €64,343 using RALP. For indirect costs, the ICER per extra successful treatment was €13,514 using RALP. The difference in effectiveness between RALP and RRP procedures was 7% in favour of RALP. In the present study no QALY was gained 1 year after RALP, however this result is uncertain due to a high degree of missing data. The sensitivity analysis did not change the results noticeably.
The study was limited by the design resulting in a low percentage of information on the effect of medication for erectile dysfunction and only short-term quality of life was measured at 1 year postoperatively.
RALP was more effective and more costly. A way to improve the cost effectiveness may be to perform RALP at fewer high volume urology centres and utilise the full potential of each robot.
评估机器人辅助腹腔镜前列腺切除术（RALP）与经耻骨后前列腺切除术（RRP）相比的成本效益和成本效用。
在一项回顾性队列研究中，共有 231 名年龄在 50 至 69 岁之间且患有临床局限性前列腺癌的男性，于 2004 年 1 月 1 日至 2007 年 12 月 31 日在奥胡斯大学医院 Skejby 泌尿科接受了根治性前列腺切除术（RP）。RALP 和 RRP 患者根据年龄和前列腺癌的 D'Amico 风险分类进行 1:2 匹配；77 例 RALP 和 154 例 RRP。进行了经济评估，以估计术后第一年的直接成本和每例成功手术治疗和每例质量调整生命年（QALY）的增量成本效益比（ICER）。成功的 RP 定义为：无残留癌症（PSA<0.2ng/ml，保留尿控和勃起功能。进行了单因素敏感性分析，以研究每次改变一个变量的影响。
使用 RALP，每例额外成功治疗的 ICER 为 64343 欧元。对于间接成本，使用 RALP，每例额外成功治疗的 ICER 为 13514 欧元。RALP 和 RRP 手术之间的疗效差异为 7%，RALP 更有利。在本研究中，RALP 治疗后 1 年没有获得 QALY，但由于数据缺失程度较高，该结果不确定。敏感性分析没有明显改变结果。
该研究受到设计的限制，导致关于勃起功能障碍药物治疗效果的信息百分比较低，并且仅在术后 1 年测量了短期生活质量。
RALP 更有效且成本更高。提高成本效益的一种方法可能是在较少的高容量泌尿科中心进行 RALP，并充分利用每个机器人的潜力。
