Lai Tzu-Jung, Heggie Robert, Kamaruzaman Hanin-Farhana, Bouttell Janet, Boyd Kathleen
Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Malaysian Health Technology Assessment Section (MaHTAS), Medical Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia.
Appl Health Econ Health Policy. 2025 Jan;23(1):35-49. doi: 10.1007/s40258-024-00920-1. Epub 2024 Sep 27.
The use of robotic-assisted surgery (RAS) is growing rapidly. However, economic evaluation of this technology is challenging. This study aims to identify and discuss the different economic evaluation methods which have been used to evaluate RAS.
This scoping review systematically searched PubMed and Embase from 2015 to 2023. We included economic evaluation studies comparing RAS versus laparoscopic or open surgery. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to aid data extraction and was extended to cover additional features relevant to RAS, including learning curve, organisational impact, incremental innovation and dynamic pricing.
A total of 50 economic evaluations of RAS were included. Cost-utility analysis (46%) was the most commonly applied economic evaluation method, followed by cost-consequence analysis (32%). The studies focused on the specialties of urology (42%), hepato-pancreato-biliary (20%), colorectal (14%) and gynaecology (6%). Distinctive features related to the assessment of RAS were under-addressed in economic evaluations. Only 40% of the included studies considered learning curve and organisational impact and less than 12% of the included studies reflected on incremental innovation and dynamic pricing.
This review found that some studies have incorporated challenges specific to RAS in their evaluations. However, most studies still lack key aspects of importance. In particular, studies rarely considered the ability of RAS platforms to be shared across multiple specialities. Incorporating these distinctive features offers an opportunity for economic evaluation to provide decision-makers with a more realistic assessment of the cost-effectiveness of this technology and to ensure its optimal utilisation in clinical practice.
机器人辅助手术（RAS）的应用正在迅速增长。然而，对这项技术进行经济评估具有挑战性。本研究旨在识别和讨论用于评估RAS的不同经济评估方法。
本范围综述系统检索了2015年至2023年的PubMed和Embase。我们纳入了比较RAS与腹腔镜手术或开放手术的经济评估研究。采用《卫生经济评估报告标准合并清单》（CHEERS）辅助数据提取，并进行了扩展，以涵盖与RAS相关的其他特征，包括学习曲线、组织影响、渐进性创新和动态定价。
共纳入了50项RAS的经济评估。成本效用分析（46%）是最常用的经济评估方法，其次是成本后果分析（32%）。这些研究主要集中在泌尿外科（42%）、肝胰胆外科（20%）、结直肠外科（14%）和妇科（6%）等专业领域。经济评估中未充分考虑与RAS评估相关的独特特征。纳入研究中只有40%考虑了学习曲线和组织影响，不到12%的纳入研究反思了渐进性创新和动态定价。
本综述发现，一些研究在评估中纳入了RAS特有的挑战。然而，大多数研究仍然缺乏重要的关键方面。特别是，研究很少考虑RAS平台跨多个专业共享的能力。纳入这些独特特征为经济评估提供了一个机会，以便为决策者提供对该技术成本效益更现实的评估，并确保其在临床实践中的最佳利用。
