General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Verona, Italy.
Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Surg Endosc. 2024 Oct;38(10):5881-5890. doi: 10.1007/s00464-024-10849-0. Epub 2024 Aug 20.
This study analyzed the Quality of Life (QoL) and cost-effectiveness of laparoscopic (LDP) versus robotic distal pancreatectomy (RDP).
Consecutive patients submitted to LDP or RDP from 2010 to 2020 in four high-volume Italian centers were included, with a minimum of 12 months of postoperative follow-up were included. QoL was evaluated using the EORTC QLQ-C30 and EQ-5D questionnaires, self-reported by patients. After a propensity score matching, which included BMI, gender, operation time, multiorgan and vascular resections, splenic preservation, and pancreatic stump management, the mean differential cost and Quality-Adjusted Life Years (QALY) were calculated and plotted on a cost-utility plane.
The study population consisted of 564 patients. Among these, 271 (49%) patients were submitted to LDP, while 293 (51%) patients to RDP. After propensity score matching, the study population was composed of 159 patients in each group, with a median follow-up of 59 months. As regards the QoL analysis, global health and emotional functioning domains showed better results in the RDP group (p = 0.037 and p = 0.026, respectively), whereas the other did not differ. As expected, the median crude costs analysis confirmed that RDP was more expensive than LDP (16,041 Euros vs. 10,335 Euros, p < 0.001). However, the robotic approach had a higher probability of being more cost-effective than the laparoscopic procedure when a willingness to pay more than 5697 Euros/QALY was accepted.
RDP was associated with better QoL as explored by specific domains. Crude costs were higher for RDP, and the cost-effectiveness threshold was set at 5697 euros/QALY.
本研究分析了腹腔镜（LDP）与机器人辅助远端胰腺切除术（RDP）在生活质量（QoL）和成本效益方面的差异。
本研究纳入了 2010 年至 2020 年期间在意大利四家高容量中心接受 LDP 或 RDP 的连续患者，术后随访时间至少为 12 个月。QoL 通过患者自我报告的 EORTC QLQ-C30 和 EQ-5D 问卷进行评估。在倾向评分匹配后，包括 BMI、性别、手术时间、多器官和血管切除、脾保留和胰腺残端处理，计算平均差异成本和质量调整生命年（QALY），并绘制在成本效益平面上。
研究人群由 564 例患者组成。其中，271 例（49%）患者接受了 LDP，293 例（51%）患者接受了 RDP。在倾向评分匹配后，每组患者各 159 例，中位随访时间为 59 个月。在 QoL 分析方面，RDP 组患者的总体健康和情绪功能领域的结果更好（p=0.037 和 p=0.026），而其他方面无差异。正如预期的那样，中位数的粗成本分析证实，RDP 比 LDP 更昂贵（16041 欧元比 10335 欧元，p<0.001）。然而，当接受支付超过 5697 欧元/QALY 的意愿时，机器人手术比腹腔镜手术更有可能具有成本效益。
RDP 与特定领域探索的 QoL 改善相关。RDP 的粗成本更高，成本效益阈值设定为 5697 欧元/QALY。
