A cost-effectiveness modeling study of robot-assisted (RARC) versus open radical cystectomy (ORC) for bladder cancer to inform future research

Michels, Charlotte T.J.; Wijburg, Carl; Leijte, Erik; Witjes, J.A.; Rovers, Maroeska M.; Grutters, Janneke P.C.

doi:10.1016/j.euf.2018.04.014

Cited by 24 publications

(18 citation statements)

References 32 publications

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“…Considering the quality of the studies, the results indicated that, in general, RARC was more likely to be expensive. Michels et al conducted a cost simulation of ORC and RARC using data from a literature review and reported that RARC was more expensive [14], similar to our study result. Leow et al reported that the cost advantage in ORC was due to the additional costs of purchasing and maintaining robots and longer operative times for RARC [24, 28].…”

Section: Discussionsupporting

confidence: 85%

“…In contrast, the cost-analysis by Bansal et al showed a total cost advantage of approximately $1945/case for ORC [13]. Michels et al [14] conducted a cost simulation of ORC and RARC and found that RARC costs €3365 more than ORC at 30 days. These studies indicated that operative time, length of stay (LOS), and the number of annual cases were key drivers of costs [14].…”

Section: Introductionmentioning

confidence: 99%

“…Michels et al [14] conducted a cost simulation of ORC and RARC and found that RARC costs €3365 more than ORC at 30 days. These studies indicated that operative time, length of stay (LOS), and the number of annual cases were key drivers of costs [14]. However, consensus regarding the most cost-effective surgical approach is yet to be reached.…”

Section: Introductionmentioning

confidence: 99%

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Cost comparison between open radical cystectomy, laparoscopic radical cystectomy, and robot-assisted radical cystectomy for patients with bladder cancer: a systematic review of segmental costs

et al. 2019

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BackgroundRobot-assisted radical cystectomy is becoming a common treatment for bladder carcinoma. However, in comparison with open radical cystectomy, its cost-effectiveness has not been confirmed. Although few published reviews have compared total costs between the two surgical procedures, no study has compared segmental costs and explained their impact on total costs.MethodsA systematic review was conducted based on studies on the segmental costs of open, laparoscopic, and robot-assisted radical cystectomy using PubMed, Web of Science, and Cochrane Library databases to provide insight into cost-effective management methods for radical cystectomy. The segmental costs included operating, robot-related, complication, and length of stay costs. A sensitivity analysis was conducted to determine the impact of the annual number of cases on the per-case robot-related costs.ResultsWe identified two studies that compared open and laparoscopic surgeries and nine that compared open and robotic surgeries. Open radical cystectomy costs were higher than those of robotic surgeries in two retrospective single-institution studies, while robot-assisted radical cystectomy costs were higher in 1 retrospective single-institution study, 1 randomized controlled trial, and 4 large database studies. Operating costs were higher for robotic surgery, and accounted for 63.1–70.5% of the total robotic surgery cost. Sensitivity analysis revealed that robot-related costs were not a large proportion of total surgery costs in institutions with a large number of cases but accounted for a large proportion of total costs in centers with a small number of cases.ConclusionsThe results show that robot-assisted radical cystectomy is more expensive than open radical cystectomy. The most effective methods to decrease costs associated with robotic surgery include a decrease in operating time and an increase in the number of cases. Further research is required on the cost-effectiveness of surgeries, including quality measures such as quality of life and quality-adjusted life years.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost comparison between open radical cystectomy, laparoscopic radical cystectomy, and robot-assisted radical cystectomy for patients with bladder cancer: a systematic review of segmental costs

et al. 2019

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“…An example of an IDEAL 2b innovation already close to generalized adoption is robot-assisted radical cystectomy. 21,43 Robot-assisted surgery is maybe one of the most discussed innovations in surgery, because it has been adopted worldwide and demand for it is still rising, despite its high costs and lack of high-quality evidence. 65 IDEAL 3 innovations were mostly close to general adoption; an example is a trial-based cost-effectiveness analysis of mitral valve replacement for severe ischemic mitral regurgitation.…”

Section: Innovation Characteristicsmentioning

confidence: 99%

The Use of Decision Analytic Modeling in the Evaluation of Surgical Innovations: A Scoping Review

Scholte¹,

Rovers²,

Grutters³

2021

Value in Health

Self Cite

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The main objective of this review was to map how decision analytic models are used in surgical innovation (in which research phase, with what aim) and to understand how challenges related to the assessment of surgical interventions are incorporated.Methods: We systematically searched PubMed, Embase, and the Cochrane Library for studies published in 2018. We included original articles using a decision analytic model to compare surgical strategies. We included modeling studies of surgical innovations. General, innovation, and modeling characteristics were extracted, as were outcomes, recommendations, and handling of challenges related to the assessment of surgical interventions (learning curve, incremental innovation, dynamic pricing, quality variation, organizational impact). Results:We included 46 studies. The number of studies increased with each research phase, from 4% (n = 2) in the preclinical phase to 40% (n = 20) in phase 3 studies. Eighty-one studies were excluded because they investigated established surgical procedures, indicating that modeling is predominantly applied after the innovation process. Regardless of the research stage, the aim to determine cost-effectiveness was most frequently identified (n = 40, 87%), whereas exploratory aims (eg, exploring when a strategy becomes cost-effective) were less common (n = 9, 20%). Most challenges related to the assessment of surgical interventions were rarely incorporated in models (eg, learning curve [n = 1, 2%], organizational impact [n = 2, 4%], and incremental innovation [n = 1, 2%]), except for dynamic pricing (n = 10, 22%) and quality variation (n = 6, 13%).Conclusions: In surgical innovation, modeling is predominantly used in later research stages to assess cost-effectiveness. The exploratory use of modeling seems still largely overlooked in surgery; therefore, the opportunity to inform research and development may not be optimally used.

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“…However, this is an expensive approach reserved for centers equipped with a robotic system. Thus, ORC remains the most widely performed approach worldwide with shorter operation times [17], equivalent oncological and perioperative outcomes at substantially reduced costs [18].…”

mentioning

confidence: 99%

Morbidity and mortality after open radical cystectomy and ileal diversion - 10 years experience and a comprehensive assessment in a single tertiary center

Carmo¹,

Babjuk²,

Vesely³

et al. 2021

neo

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Open radical cystectomy (ORC) remains the gold standard for the treatment of muscle-invasive and high-risk non-muscle invasive bladder cancer unsuitable for bladder preservation techniques.Despite improvements in operative technique and perioperative care, it continues to be associated with significant complications. We analyzed our series of prospectively collected data of patients that underwent ORC at a tertiary referral academic center and evaluated early and late postoperative complications and mortality. The records of 391 ORCs with ileal diversion performed at our institution between January 2008 and July 2018 for non-metastatic transitional bladder carcinoma and other distinct pathological types were analyzed. Perioperative mortality was determined and 30day and 90-day complications were reported according to the Martin Criteria and the European Association of Urology and graded according to the five-grade Clavien-Dindo classification.Univariate and multivariate analyses were used to evaluate predictors of complications and mortality. Gastrointestinal and infectious complications represented 41% and 43% of the total complications observed at 30 and 90 days from the surgery, respectively. The strongest predictor of infectious complications was the ch Diabetes was a predictor of the overall, major and major infectious complications (p < 0.05). The 30-day mortality rate was 1% while the 90predictor of mortality at both 30-days (p-value 0.003) and 90-days (p-value 0.01) in univariate and multivariate analyses. ORC is a morbid procedure, associated with a high mortality rate. Elderly patients should have proper counseling before indication of this procedure. Gastrointestinal and infectious complications represent the most common and serious complications, and the study of their predictors is of the utmost importance.

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A cost-effectiveness modeling study of robot-assisted (RARC) versus open radical cystectomy (ORC) for bladder cancer to inform future research

Abstract: 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.

Cited by 24 publications

References 32 publications

Cost comparison between open radical cystectomy, laparoscopic radical cystectomy, and robot-assisted radical cystectomy for patients with bladder cancer: a systematic review of segmental costs

Cost comparison between open radical cystectomy, laparoscopic radical cystectomy, and robot-assisted radical cystectomy for patients with bladder cancer: a systematic review of segmental costs

The Use of Decision Analytic Modeling in the Evaluation of Surgical Innovations: A Scoping Review

Morbidity and mortality after open radical cystectomy and ileal diversion - 10 years experience and a comprehensive assessment in a single tertiary center

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