Economic evaluation of robot-assisted radical prostatectomy compared to open radical prostatectomy for prostate cancer treatment in Ontario, Canada

Abstract

Introduction: Recent health technology assessments (HTAs) of robot-assisted radical prostatectomy (RARP) in Ontario and Alberta, Canada, resulted in opposite recommendations, calling into question whether benefits of RARP offset the upfront investment. Therefore, the study objectives were to conduct a cost-utility analysis from a Canadian public payer perspective to determine the cost-effectiveness of RARP.
 Methods: Using a 10-year time horizon, a five-state Markov model was developed to compare RARP to open radical prostatectomy (ORP). Clinical parameters were derived from Canadian observational studies and a recently published systematic review. Costs, resource utilization, and utility values from recent Canadian sources were used to populate the model. Results were presented in terms of increment costs per quality-adjusted life years (QALYs) gained. A probabilistic analysis was conducted, and uncertainty was represented using cost-effectiveness acceptability curves (CEACs). One-way sensitivity analyses were also conducted. Future costs and QALYs were discounted at 1.5%.
 Results: Total cost of RARP and ORP were $47 033 and $45 332, respectively. Total estimated QALYs were 7.2047 and 7.1385 for RARP and ORP, respectively. The estimated incremental cost-utility ratio (ICUR) was $25 704 in the base-case analysis. At a willingness-to-pay threshold of $50 000 and $100 000 per QALY gained, the probability of RARP being cost-effective was 0.65 and 0.85, respectively. The model was most sensitive to the time horizon.
 Conclusions: The results of this analysis suggest that RARP is likely to be cost-effective in this Canadian patient population. The results are consistent with Alberta’s HTA recommendation and other economic evaluations, but challenges Ontario’s reimbursement decision.

More work is needed on cost‐utility analyses of robotic‐assisted surgery

“…Most studies were then excluded because they did not meet the “cost‐utility analyses” criterion, or because they were not primary studies reporting results of an economic evaluation (e.g., reviews), or because they were duplicates. After the full‐text screening, 31 studies 31–61 were included for data extraction and quality assessment. Further details are presented in the PRISMA flow diagram (Figure 1).…”

Cost-effectiveness of Robotic-Assisted Radical Prostatectomy for Localized Prostate Cancer in the UK

“… 34 Similarly, the impact of case volume on cost-effectiveness was also demonstrated. 7 , 9 The NICE recommends the use of RARP at centers with more than 150 cases per system per year to achieve superior cost-effectiveness over LRP. Our study showed that RARP is more cost-effective than ORP and LRP at an annual volume of 250 cases per system, which reflects the current use of the robotic system across different specialties in the UK, 35 as well as at an annual volume of 150 cases as recommended by the NICE.…”

“…A UK economic assessment by the National Institute for Health Research in 2012 showed that RARP was more cost-effective than LRP for 10 years when the annual volume per system exceeded 150 cases. 7 Although other studies have examined the cost-effectiveness of RARP, 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 conclusive evidence is still lacking and warrants further research. Emergence of recent clinical data provides an opportunity to develop a more robust cost-effectiveness model.…”

Laparoscopic surgery experience does not influence oncological and functional results of robotic-assisted laparoscopic prostatectomy

“…8,10,11 Robotic surgery is about 1400 Pounds more expensive per case than laparoscopic surgery 12 and approximately 1700 Dollars more expensive than open surgery. 13 In published studies until 2005, it has been stated that 12-20 cases are required for proficiency in robotic-assisted laparoscopic prostatectomy. 14,15 In the following years Herrell and Smith 16 have said that at least 150 cases should be made to make a comparison in the following years and even this number should be 250 for the surgeon to feel comfortable.…”

“…8,10,11 Robotic surgery is about 1400 Pounds more expensive per case than laparoscopic surgery 12 and approximately 1700 Dollars more expensive than open surgery. 13…”