Urology Department, Nancy University Hospital, Site de Brabois, rue du Morvan, Vandœuvre-lès-Nancy, France.
Centre for Clinical Epidemiology CIC 1433 Inserm, Nancy University Hospital, Site de Brabois, Nancy, France.
J Robot Surg. 2023 Aug;17(4):1571-1578. doi: 10.1007/s11701-023-01552-8. Epub 2023 Mar 15.
To evaluate the cost-effectiveness of robotic-assisted surgery compared to open surgery in the context of partial nephrectomy for small kidney tumor management. This is a retrospective study using data from 395 patients operated on by either robot-assisted surgery (RAPN) or by open partial nephrectomy (OPN); one hospital performed RAPN exclusively and the second hospital, OPN exclusively. Cost-effectiveness analysis was conducted from the perspective of the National Health Insurance System (NHIS) by considering the costs of the initial hospital stay and the cost of complications. Clinical outcome was defined by the avoidance of major complications during the 12 months postoperatively. Major complications were absent in 82% of patients in the OPN group and 93% of patients in the RAPN group, with 11% in favor of robotic assistance (p < 0.001). The average cost per patient, including the costs of complications, were, respectively, 9637 € and 8305 € for the OPN and RAPN groups. Robotic assistance was associated with a 1332 € lower cost (p < 0.001). The incremental cost-effectiveness ratio (ICER) is estimated at - 12,039 €. From the perspective of the public payer, robotic assistance was associated with a lower rate of postoperative complications and a lower average cost per patient. Robotic-assisted surgery was an efficient alternative to open surgery in partial nephrectomy. Trial registration number: NCT05089006 (October 22, 2021).
评估机器人辅助手术与开放手术在小肾肿瘤管理的部分肾切除术方面的成本效益。这是一项回顾性研究，使用了 395 名接受机器人辅助手术（RAPN）或开放部分肾切除术（OPN）治疗的患者的数据；一家医院专门进行 RAPN，另一家医院专门进行 OPN。成本效益分析从国家健康保险系统（NHIS）的角度进行，考虑了初始住院费用和并发症费用。临床结果定义为避免术后 12 个月内发生重大并发症。OPN 组 82%的患者和 RAPN 组 93%的患者无重大并发症，机器人辅助组有 11%的患者受益（p<0.001）。包括并发症费用在内，OPN 和 RAPN 组的每位患者平均费用分别为 9637 欧元和 8305 欧元。机器人辅助治疗的成本降低了 1332 欧元（p<0.001）。增量成本效益比（ICER）估计为-12039 欧元。从公共支付者的角度来看，机器人辅助治疗与术后并发症发生率降低和每位患者平均成本降低有关。机器人辅助手术是部分肾切除术的一种有效替代开放手术的方法。试验注册号：NCT05089006（2021 年 10 月 22 日）。
