Division of Urological Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
MRC (Medical Research Council) Centre for Transplantation, Guy's Hospital Campus, King's College London, King's Health Partners, London, United Kingdom.
JAMA Netw Open. 2022 Apr 1;5(4):e225740. doi: 10.1001/jamanetworkopen.2022.5740.
The cost-effectiveness of different surgical techniques for radical prostatectomy remains a subject of debate. Emergence of recent critical clinical data and changes in surgical equipment costs due to their shared use by different clinical specialties necessitate an updated cost-effectiveness analysis in a centralized, largely government-funded health care system such as the UK National Health Service (NHS).
To compare robotic-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) and laparoscopic-assisted radical prostatectomy (LRP) using contemporary data on clinical outcomes, costs, and surgical volumes in the UK.
DESIGN, SETTING, AND PARTICIPANTS: This economic analysis used a Markov model developed to compare the cost-effectiveness of RARP, LRP, and ORP to treat localized prostate cancer. The model was constructed from the perspective of the UK NHS. The model simulated 65-year-old men who underwent radical prostatectomy for localized prostate cancer and were followed up for a 10-year period. Data were analyzed from May 1, 2020, to July 31, 2021.
Robotic-assisted radical prostatectomy, LRP, and ORP.
Quality-adjusted life-years (QALYs), costs (direct medical costs and costs outside the NHS), and incremental cost-effectiveness ratios (ICERs).
Compared with LRP, RARP cost £1785 (US $2350) less and had 0.24 more QALYs gained; thus, RARP was a dominant option compared with LRP. Compared with ORP, RARP had 0.12 more QALYs gained but cost £526 (US $693) more during the 10-year time frame, resulting in an ICER of £4293 (US $5653)/QALY. Because the ICER was below the £30 000 (US $39 503) willingness-to-pay threshold, RARP was more cost-effective than ORP in the UK. The most sensitive variable influencing the cost-effectiveness of RARP was the lower risk of biochemical recurrence (BCR). Scenario analysis indicated RARP would remain more cost-effective than ORP as long as the BCR hazard ratios comparing RARP vs ORP were less than 0.99.
These findings suggest that in the UK, RARP has an ICER lower than the willingness-to-pay threshold and thus is likely a cost-effective surgical treatment option for patients with localized prostate cancer compared with ORP and LRP. The results were mainly driven by the lower risk of BCR for RARP. These findings may differ in other health care settings where different thresholds and costs may apply.
不同根治性前列腺切除术的成本效益仍然是一个争论的话题。由于不同临床专业共同使用，最近出现了关键的临床数据和手术设备成本的变化，因此在英国这样的集中式、主要由政府资助的医疗保健系统中，需要进行更新的成本效益分析。
使用英国临床结局、成本和手术量的最新数据，比较机器人辅助根治性前列腺切除术（RARP）与开放性根治性前列腺切除术（ORP）和腹腔镜辅助根治性前列腺切除术（LRP）。
设计、设置和参与者：这项经济分析使用了一个马尔可夫模型，该模型用于比较 RARP、LRP 和 ORP 治疗局限性前列腺癌的成本效益。该模型是从英国国民保健制度（NHS）的角度构建的。该模型模拟了 65 岁接受局限性前列腺癌根治性前列腺切除术的男性，并随访了 10 年。数据于 2020 年 5 月 1 日至 2021 年 7 月 31 日进行分析。
机器人辅助根治性前列腺切除术、LRP 和 ORP。
质量调整生命年（QALYs）、成本（直接医疗成本和 NHS 以外的成本）和增量成本效益比（ICERs）。
与 LRP 相比，RARP 节省了 1785 英镑（2350 美元），获得了 0.24 个 QALYs；因此，与 LRP 相比，RARP 是一种更具优势的选择。与 ORP 相比，RARP 获得了 0.12 个 QALYs，但在 10 年的时间内成本增加了 526 英镑（693 美元），导致 ICER 为 4293 英镑（5653 美元）/QALY。由于 ICER 低于 30000 英镑（39503 美元）的意愿支付阈值，因此 RARP 在英国比 ORP 更具成本效益。影响 RARP 成本效益的最敏感变量是生化复发（BCR）的风险较低。情景分析表明，只要 RARP 与 ORP 相比的 BCR 风险比小于 0.99，RARP 就将继续比 ORP 更具成本效益。
这些发现表明，在英国，RARP 的 ICER 低于意愿支付阈值，因此与 ORP 和 LRP 相比，RARP 可能是治疗局限性前列腺癌的一种具有成本效益的手术治疗选择。结果主要是由于 RARP 的 BCR 风险较低。这些发现可能因不同的卫生保健环境而异，因为在这些环境中可能适用不同的阈值和成本。
