Hepato Pancreato Biliary Unit, Hospital del Mar, Pompeu Fabra University, Barcelona, Spain.
Department of Surgical Science, University of Cagliari, Policlinico Universitario "D. Casula", Azienda Ospedaliero-Universitaria Di Cagliari, Cagliari, Italy.
Surg Endosc. 2024 Nov;38(11):6270-6281. doi: 10.1007/s00464-024-11109-x. Epub 2024 Aug 13.
Although several studies report that the robotic approach is more costly than laparoscopy, the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) is still an issue. This study evaluates the cost-effectiveness of the RDP and LDP approaches across several Spanish centres.
This study is an observational, multicenter, national prospective study (ROBOCOSTES). For one year from 2022, all consecutive patients undergoing minimally invasive distal pancreatectomy were included, and clinical, QALY, and cost data were prospectively collected. The primary aim was to analyze the cost-effectiveness between RDP and LDP.
During the study period, 80 procedures from 14 Spanish centres were analyzed. LDP had a shorter operative time than the RDP approach (192.2 min vs 241.3 min, p = 0.004). RDP showed a lower conversion rate (19.5% vs 2.5%, p = 0.006) and a lower splenectomy rate (60% vs 26.5%, p = 0.004). A statistically significant difference was reported for the Comprehensive Complication Index between the two study groups, favouring the robotic approach (12.7 vs 6.1, p = 0.022). RDP was associated with increased operative costs of 1600 euros (p < 0.031), while overall cost expenses resulted in being 1070.92 Euros higher than the LDP but without a statistically significant difference (p = 0.064). The mean QALYs at 90 days after surgery for RDP (0.9534) were higher than those of LDP (0.8882) (p = 0.030). At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was a 62.64% and 71.30% probability that RDP was more cost-effective than LDP, respectively.
The RDP procedure in the Spanish healthcare system appears more cost-effective than the LDP.
尽管有几项研究报告称机器人手术方法比腹腔镜手术方法更昂贵，但机器人辅助胰体尾切除术（RDP）相对于腹腔镜胰体尾切除术（LDP）的成本效益仍然是一个问题。本研究评估了几个西班牙中心的 RDP 和 LDP 方法的成本效益。
这是一项观察性、多中心、全国前瞻性研究（ROBOCOSTES）。从 2022 年开始的一年中，纳入了所有接受微创胰体尾切除术的连续患者，并前瞻性地收集了临床、QALY 和成本数据。主要目的是分析 RDP 和 LDP 之间的成本效益。
在研究期间，分析了来自 14 个西班牙中心的 80 例手术。LDP 的手术时间短于 RDP 方法（192.2 分钟比 241.3 分钟，p=0.004）。RDP 的转化率较低（19.5%比 2.5%，p=0.006），脾切除术率较低（60%比 26.5%，p=0.004）。两组之间的综合并发症指数有统计学显著差异，机器人方法更有利（12.7 比 6.1，p=0.022）。RDP 的手术费用增加了 1600 欧元（p<0.031），而总费用比 LDP 高出 1070.92 欧元，但无统计学显著差异（p=0.064）。RDP 术后 90 天的平均 QALY（0.9534）高于 LDP（0.8882）（p=0.030）。在愿意支付的 20000 欧元和 30000 欧元阈值下，RDP 比 LDP 更具成本效益的概率分别为 62.64%和 71.30%。
在西班牙医疗保健系统中，RDP 手术程序比 LDP 更具成本效益。
