Charlotte T J Michels1, Carl J Wijburg2, Erik Leijte3, J Alfred Witjes4, Maroeska M Rovers3, Janneke P C Grutters3. 1. Department of Urology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands. Electronic address: CMichels@rijnstate.nl. 2. Department of Urology, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands. 3. Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands. 4. Department of Urology, Radboud University Medical Center, Geert Grooteplein Noord 21, 6500 HB, Nijmegen, The Netherlands.
Abstract
BACKGROUND: Open radical cystectomy (ORC) is regarded the standard treatment for muscle-invasive bladder cancer, but robot-assisted radical cystectomy (RARC) is increasingly used in practice. However, it is unclear whether RARC provides value for money. OBJECTIVE: To identify the main evidence gaps and main drivers of cost-effectiveness, comparing RARC to ORC. DESIGN, SETTING, AND PARTICIPANTS: A decision analytical model was developed to study the 30d and 90d postoperative complications with RARC versus ORC and their related cost in bladder cancer patients. Input data were derived from systematic literature searches, meta-analyses, internal databases and expert opinion. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cost per saved complication (in Clavien-Dindo grading) was determined. Deterministic sensitivity analyses was performed to search for threshold values for RARC to become cost saving. Uncertainty was addressed using probabilistic sensitivity analyses. RESULTS: The expected 30d and 90d risk for a minor complication was lower for RARC than ORC (37% vs. 45% and 32% vs. 36%). The expected 30d and 90d risk of RARC versus ORC for a major complication was 18% vs. 23% and 16% vs. 25%. The 30d and 90d extra costs needed to prevent one major complication were €62,582 and €37,007, respectively. Data on the impact of complications on quality of life were lacking. Three scenarios resulted in cost savings for RARC: operating time (threshold: ≤175min), length of stay (≤4d), and RARC equipment (≤€281). CONCLUSION: Current evidence suggests that it is unlikely that RARC will become less expensive than ORC. However, RARC might result in fewer complications. To determine value for money, research is needed into the consequences of these complications in terms of quality of life. PATIENT SUMMARY: Economic modeling showed that RARC might result in fewer complications, but is more expensive than ORC. Future research should focus on the impact on quality of life.
BACKGROUND: Open radical cystectomy (ORC) is regarded the standard treatment for muscle-invasive bladder cancer, but robot-assisted radical cystectomy (RARC) is increasingly used in practice. However, it is unclear whether RARC provides value for money. OBJECTIVE: To identify the main evidence gaps and main drivers of cost-effectiveness, comparing RARC to ORC. DESIGN, SETTING, AND PARTICIPANTS: A decision analytical model was developed to study the 30d and 90d postoperative complications with RARC versus ORC and their related cost in bladder cancer patients. Input data were derived from systematic literature searches, meta-analyses, internal databases and expert opinion. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Cost per saved complication (in Clavien-Dindo grading) was determined. Deterministic sensitivity analyses was performed to search for threshold values for RARC to become cost saving. Uncertainty was addressed using probabilistic sensitivity analyses. RESULTS: The expected 30d and 90d risk for a minor complication was lower for RARC than ORC (37% vs. 45% and 32% vs. 36%). The expected 30d and 90d risk of RARC versus ORC for a major complication was 18% vs. 23% and 16% vs. 25%. The 30d and 90d extra costs needed to prevent one major complication were €62,582 and €37,007, respectively. Data on the impact of complications on quality of life were lacking. Three scenarios resulted in cost savings for RARC: operating time (threshold: ≤175min), length of stay (≤4d), and RARC equipment (≤€281). CONCLUSION: Current evidence suggests that it is unlikely that RARC will become less expensive than ORC. However, RARC might result in fewer complications. To determine value for money, research is needed into the consequences of these complications in terms of quality of life. PATIENT SUMMARY: Economic modeling showed that RARC might result in fewer complications, but is more expensive than ORC. Future research should focus on the impact on quality of life.
Authors: Angelo Porreca; Luca Di Gianfrancesco; Walter Artibani; Gian Maria Busetto; Giuseppe Carrieri; Alessandro Antonelli; Lorenzo Bianchi; Eugenio Brunocilla; Aldo Massimo Bocciardi; Marco Carini; Antonio Celia; Giovanni Cochetti; Andrea Gallina; Ettore Mearini; Andrea Minervini; Riccardo Schiavina; Sergio Serni; Daniele D'Agostino; Erica Debbi; Paolo Corsi; Alessandro Crestani Journal: Cent European J Urol Date: 2022-05-04
Authors: Sejal Patel; Maroeska M Rovers; Michiel J P Sedelaar; Petra L M Zusterzeel; Ad F T M Verhagen; Camiel Rosman; Janneke P C Grutters Journal: BMJ Surg Interv Health Technol Date: 2021-02-05