Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA.
Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA.
Surg Endosc. 2023 Sep;37(9):6806-6817. doi: 10.1007/s00464-023-10119-5. Epub 2023 Jun 1.
Robotic approach in paraesophageal hernia (PEH) repair may improve outcomes over laparoscopic approach, though at additional cost. This study aimed to compare cost-effectiveness of robotic and laparoscopic PEH repair.
A decision tree was created analyzing cost-effectiveness of robotic and laparoscopic PEH repair. Costs were obtained from 2021 Medicare data and were accumulated within 60 months after surgery. Effectiveness was measured in quality-adjusted life-years (QALYs). Branch-point probabilities and costs of robotic surgery consumables were obtained from published literature. The primary outcome of interest was incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were performed. A secondary analysis including attributable capital and maintenance costs of robotic surgery was conducted as well.
Laparoscopic repair yielded 3.660 QALYs at $35,843.82. Robotic repair yielded 3.661 QALYs at $36,342.57, with an ICER of $779,488.62/QALY. Robotic repair was favored when rates of open conversion and symptom recurrence were low, or with reduced cost of robotic instruments. A probabilistic sensitivity analysis favored laparoscopic repair in 100% of simulations. When accounting for costs of robotic technology, robotic approach was preferred only in unrealistic clinical scenarios.
Laparoscopic repair is likely more cost-effective for most institutions, though results were relatively similar. With experienced surgeons who surpass the initial learning curve, robotic surgery may improve outcomes enough to be cost-effective, but only when excluding capital and maintenance fees.
机器人方法在食管裂孔疝（PEH）修复中可能比腹腔镜方法改善结果，但成本更高。本研究旨在比较机器人和腹腔镜 PEH 修复的成本效益。
创建决策树分析机器人和腹腔镜 PEH 修复的成本效益。成本从 2021 年医疗保险数据中获得，并在手术后 60 个月内累积。有效性以质量调整生命年（QALY）衡量。机器人手术耗材的分支点概率和成本从已发表的文献中获得。主要观察结果是增量成本效益比（ICER）。进行了单因素、双因素和概率敏感性分析。还进行了包括机器人手术可归因资本和维护成本的二次分析。
腹腔镜修复产生 3.660 个 QALY，成本为 35843.82 美元。机器人修复产生 3.661 个 QALY，成本为 36342.57 美元，ICER 为 7794886.22 美元/QALY。当开放转换和症状复发的发生率较低时，或者机器人器械的成本降低时，机器人修复更有利。在 100%的模拟中，概率敏感性分析都倾向于腹腔镜修复。当考虑机器人技术的成本时，只有在不切实际的临床情况下，机器人方法才更受青睐。
对于大多数机构来说，腹腔镜修复可能更具成本效益，但结果相对相似。对于经验丰富的外科医生，当他们超过初始学习曲线时，机器人手术可能会改善结果，从而具有成本效益，但仅在排除资本和维护费用的情况下。
