Stephan Buse1,2, Carolin E Hach3, Phillip Klumpen3, Assen Alexandrov3, Rene Mager4, Alexandre Mottrie5,6, Axel Haferkamp4. 1. Department of Urology and Urologic Oncology, Alfried Krupp Krankenhaus, Essen, Germany. stephan.buse@krupp-krankenhaus.de. 2. Department of Urology and Pediatric Urology, University Hospital of Frankfurt, Frankfurt, Germany. stephan.buse@krupp-krankenhaus.de. 3. Department of Urology and Urologic Oncology, Alfried Krupp Krankenhaus, Essen, Germany. 4. Department of Urology and Pediatric Urology, University Hospital of Frankfurt, Frankfurt, Germany. 5. OLV Vattikuti Robotic Surgery Institute, OLV Hospital Aalst, Aalst, Belgium. 6. Department of Urology, OLV Hospital Aalst, Aalst, Belgium.
Abstract
PURPOSE: To evaluate the cost-effectiveness of robot-assisted partial nephrectomy (RAPN) and secondarily of laparoscopic PN (LPN) compared to the open procedure. METHODS: Model-based cost-effectiveness analysis: The model was structured as decision tree. The model was populated with published data. We measured intraoperative, postoperative complications, and inhospital deaths. We expressed costs in US dollars ($).The reference analysis calculated the mean cost and the mean number of each endpoint over 5000 iterations using a second-order Monte Carlo simulation. We conducted extensive sensitivity analyses. RESULTS: The mean inhospital costs were $13,186 for RAPN, $10,782 for LPN, and $12,539 for open partial nephrectomy (OPN), respectively. The incremental cost to prevent an inhospital event amounted to $5005 for RAPN compared to OPN. Lower RENAL scores were associated with lower incremental cost per avoided complications. Under assumption of 55 % higher costs in patients with complications, RAPN dominated OPN. LPN dominated OPN. We are aware of the following limitations: First, cost data for patients with and without complications were not available and we assumed the median cost for all cases, i.e., the analysis overestimated the cost associated with RAPN; second, we focused on inhospital estimates and did not apply a societal perspective. CONCLUSIONS: RAPN appears to be a cost-effective mean to avoid inhospital complications; however, these results might not apply to low-volume hospitals or to other health care systems.
PURPOSE: To evaluate the cost-effectiveness of robot-assisted partial nephrectomy (RAPN) and secondarily of laparoscopic PN (LPN) compared to the open procedure. METHODS: Model-based cost-effectiveness analysis: The model was structured as decision tree. The model was populated with published data. We measured intraoperative, postoperative complications, and inhospital deaths. We expressed costs in US dollars ($).The reference analysis calculated the mean cost and the mean number of each endpoint over 5000 iterations using a second-order Monte Carlo simulation. We conducted extensive sensitivity analyses. RESULTS: The mean inhospital costs were $13,186 for RAPN, $10,782 for LPN, and $12,539 for open partial nephrectomy (OPN), respectively. The incremental cost to prevent an inhospital event amounted to $5005 for RAPN compared to OPN. Lower RENAL scores were associated with lower incremental cost per avoided complications. Under assumption of 55 % higher costs in patients with complications, RAPN dominated OPN. LPN dominated OPN. We are aware of the following limitations: First, cost data for patients with and without complications were not available and we assumed the median cost for all cases, i.e., the analysis overestimated the cost associated with RAPN; second, we focused on inhospital estimates and did not apply a societal perspective. CONCLUSIONS:RAPN appears to be a cost-effective mean to avoid inhospital complications; however, these results might not apply to low-volume hospitals or to other health care systems.
Entities:
Keywords:
Cost-effectiveness; Minimal invasive surgery; Partial nephrectomy; Robotic surgery
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