Tang Yunkai, Dou Bing
School of Law and Politic, Zhejiang Sci-Tech University, Hangzhou, China.
School of Management, South-Central Minzu University, Wuhan, China.
Front Public Health. 2025 Aug 12;13:1614654. doi: 10.3389/fpubh.2025.1614654. eCollection 2025.
The objective of this research is to assess the economic viability of robotic interventions in the management of healthcare for the aging demographic by conducting a Systematic Review and Meta-Analysis (SR/MA) of Randomized Controlled Trials (RCTs).
We conducted a SR/MA following the PRISMA guidelines and the Cochrane Collaboration recommendations. Studies of interest were pinpointed within various databases, encompassing PubMed, Web of Science, and the Cochrane Library, up until the cutoff date of November 2024. Inclusion criteria were based on the PICOS framework, focusing on older patients (≥60 years old), robotic or robot-assisted interventions, cost-related outcomes, and RCTs. The data were subjected to statistical evaluation via Stata 17 software, wherein mean discrepancies (MD) and standardized mean discrepancies (SMD) were computed, accompanied by 95% confidence intervals (CI) for precision. Sensitivity analyses were conducted to address heterogeneity.
Five RCTs involving 666 patients were included. The findings revealed that robotic surgery incurred higher total costs compared to traditional surgical approaches (MD = 1316.38, 95% CI 10.68-2622.08; = 0.048, = 92.5%). Subgroup analysis revealed that operating room costs were notable higher for robotic surgeries (MD = 1151.14, 95% CI 824.63-1477.64; = 0.000, = 0.0%), while hospitalization costs were lower but not statistically significant. Quality-adjusted life year (QALY) gains were statistically significant for robotic surgeries (MD = 0.01, 95% CI 0.00-0.02; = 0.010, = 0.0%). Incremental cost-effectiveness analyses showed that robotic surgery achieved cost-effectiveness in some cases, with incremental costs per QALY ranging from $14,925.62 to $28,860, both below the commonly accepted threshold of $50,000.
Robotic surgery demonstrate potential cost-effectiveness in older individuals, particularly by improving QALY and reducing long-term healthcare costs. However, the high initial investment remains a significant barrier to adoption. Future research should focus on standardizing economic evaluations, exploring specific applications of robotic therapies, and addressing long-term cost and clinical outcomes to better inform healthcare policy and practice.
本研究的目的是通过对随机对照试验（RCT）进行系统评价和荟萃分析（SR/MA），评估机器人干预在老年人口医疗保健管理中的经济可行性。
我们按照PRISMA指南和Cochrane协作组的建议进行了SR/MA。在截至2024年11月的截止日期之前，在包括PubMed、科学网和Cochrane图书馆在内的各种数据库中确定了感兴趣的研究。纳入标准基于PICOS框架，重点关注老年患者（≥60岁）、机器人或机器人辅助干预、与成本相关的结果以及RCT。通过Stata 17软件对数据进行统计评估，计算平均差异（MD）和标准化平均差异（SMD），并伴有95%置信区间（CI）以提高精度。进行敏感性分析以解决异质性问题。
纳入了5项涉及666名患者的RCT。研究结果显示，与传统手术方法相比，机器人手术的总成本更高（MD = 1316.38，95% CI 10.68 - 2622.08；P = 0.048，I² = 92.5%）。亚组分析显示，机器人手术的手术室成本显著更高（MD = 1151.14，95% CI 824.63 - 1477.64；P = 0.000，I² = 0.0%），而住院成本较低但无统计学意义。机器人手术的质量调整生命年（QALY）增益具有统计学意义（MD = 0.01，95% CI 0.00 - 0.02；P = 0.010，I² = 0.0%）。增量成本效益分析表明，机器人手术在某些情况下实现了成本效益，每QALY的增量成本在14,925.62美元至28,860美元之间，均低于普遍接受的50,000美元阈值。
机器人手术在老年人中显示出潜在的成本效益，特别是通过改善QALY和降低长期医疗成本。然而，高昂的初始投资仍然是采用的重大障碍。未来的研究应专注于标准化经济评估、探索机器人疗法的具体应用，以及解决长期成本和临床结果问题，以便更好地为医疗政策和实践提供信息。
