Faria Eliney Ferreira, Rosim Ricardo Papaléo, de Matos Nogueira Ernesto, Tobias-Machado Marcos
Department of Urology, Hospital Felicio Rocho, Belo Horizonte, Brazil.
ValueConnected, São Paulo, Brazil.
Value Health Reg Issues. 2022 May;29:60-65. doi: 10.1016/j.vhri.2021.06.009. Epub 2021 Nov 19.
Radical prostatectomy (RP) is the gold standard for the surgical treatment of localized prostate cancer, presenting better results than radiotherapy especially for high-risk patients. Although it has clinical and technical benefits compared with open and laparoscopic techniques, the robotic-assisted RP is not publicly funded in Brazil. The objective of this study was to calculate the cost-effectiveness of the robotic-assisted RP from the Brazilian public system perspective.
A state transition model was built to simulate the life of a patient undergoing RP. A total of 3 arms were compared: robotic-assisted, laparoscopic, and open surgeries. The assumed time horizon was 20 years; discounts were applied to both costs and health outcomes. Events and transition probabilities were obtained in the literature, and costs were obtained in official government databases. The results were reported as incremental cost-utility ratios.
Robotic-assisted surgery was found to be costlier but more effective than both open and laparoscopic techniques, resulting in Brazilian reals 4518 per quality-adjusted life-year and Brazilian reals 3631 per quality-adjusted life-year incremental cost-effectiveness ratios, respectively.
This study gives relevant inputs for decision making regarding the inclusion of robotic-assisted RP in the Brazilian public formularies. The study demonstrates that the technology is cost-effective even when considering willingness-to-pay thresholds lower than the traditionally used ones.
根治性前列腺切除术（RP）是局限性前列腺癌手术治疗的金标准，尤其是对于高危患者，其效果优于放射治疗。尽管与开放手术和腹腔镜手术技术相比，机器人辅助RP具有临床和技术优势，但在巴西，机器人辅助RP并非由公共资金资助。本研究的目的是从巴西公共系统的角度计算机器人辅助RP的成本效益。
构建一个状态转换模型来模拟接受RP治疗的患者的生命历程。共比较了3种术式：机器人辅助手术、腹腔镜手术和开放手术。假设的时间跨度为20年；对成本和健康结果均应用了贴现。从文献中获取事件和转换概率，并从政府官方数据库中获取成本。结果以增量成本效用比报告。
发现机器人辅助手术比开放手术和腹腔镜手术技术成本更高但更有效，增量成本效益比分别为每质量调整生命年4518巴西雷亚尔和每质量调整生命年3631巴西雷亚尔。
本研究为巴西公共药品目录中纳入机器人辅助RP的决策提供了相关依据。该研究表明，即使考虑到支付意愿阈值低于传统使用的阈值，该技术仍具有成本效益。
