Research Unit of Gynecology and Obstetrics, Odense University Hospital, Kloevervaenget 10, 10th Floor, 5000 Odense C, Denmark; Faculty of Health Sciences, Department of Clinical Research, University of Southern Denmark, J.B. Winsloews Vej 19, 5000 C, Denmark; Odense Patient Data Explorative Network (OPEN), Department of Clinical Research, University of Southern Denmark and Odense University Hospital, J.B. Winsloews Vej 9, 3rd Floor, 5000 Odense C, Denmark; Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, J.B. Winsloews Vej 9B, 1st Floor, 5000 Odense C, Denmark.
Danish Centre for Health Economics (DaCHE), Department of Public Health, University of Southern Denmark, J.B. Winsloews Vej 9B, 1st Floor, 5000 Odense C, Denmark.
Gynecol Oncol. 2019 Aug;154(2):411-419. doi: 10.1016/j.ygyno.2019.05.027. Epub 2019 Jun 5.
The majority of cost-studies related to robotic surgery has a short follow-up and primarily report the costs from the index surgery. The aim of this study was to evaluate the long-term resource consequences of introducing robotic surgery for early stage endometrial cancer in Denmark.
The study included all women with early stage endometrial cancer who underwent robotic, laparoscopic and open access surgery from January 2008 to June 2015. Data was linked from national databases to determine resource consumption and costs from hospital treatments, outpatient contacts, primary health care sector visits, labor market affiliation and prescription of medication. Each patient was observed in a period of 12 months before- and after surgery. The key exposure variable was women who were exposed to robotic surgery compared to those who were not.
A total of 4133 women underwent surgery for early stage endometrial cancer. The study found additional costs of $7309 (95% confidence interval [CI] 2100-11,620, P = 0.001) per patient in the group exposed to robotic surgery including long-term costs post-surgery compared to the non-exposed group (non-robotic group). When controlling for time trends, the introduction of robotic surgery did not reduce the number of bed days (mean diff -0.42, 95% CI -3.03-2.19, P = 0.752).
The introduction of robotic surgery for early stage endometrial cancer did not generate any long-term cost savings. The additional costs of robotic surgery were primarily driven by the index surgery. Any reduction in bed days could be explained by time trends.
大多数与机器人手术相关的成本研究随访时间都较短，主要报告了索引手术的成本。本研究旨在评估在丹麦引入机器人手术治疗早期子宫内膜癌的长期资源后果。
本研究纳入了 2008 年 1 月至 2015 年 6 月期间所有接受机器人、腹腔镜和开放手术治疗的早期子宫内膜癌女性患者。数据来自国家数据库，用于确定手术前后 12 个月内来自医院治疗、门诊接触、初级保健部门就诊、劳动力市场隶属关系和药物处方的资源消耗和成本。每位患者在手术前后均进行了观察。主要暴露变量是接受机器人手术的女性与未接受机器人手术的女性。
共有 4133 名女性接受了早期子宫内膜癌手术。研究发现，与未暴露于机器人手术的女性相比，暴露于机器人手术的女性患者每例的长期术后成本增加 7309 美元（95%置信区间 [CI]：2100-11620 美元，P=0.001）。与非暴露组相比，机器人手术的引入并没有减少住院天数（平均差值 -0.42，95%CI：-3.03-2.19，P=0.752）。
机器人手术治疗早期子宫内膜癌并未产生任何长期成本节约。机器人手术的额外成本主要由索引手术驱动。任何住院天数的减少都可以用时间趋势来解释。
