Cost-effectiveness of robot-assisted total hysterectomy for benign pathologies compared to laparoscopic surgery: A retrospective study with propensity score - 03/08/24

Doi : 10.1016/j.jogoh.2024.102821

Richard Paul-Dehlinger ^a,^g, Alexandra Vappereau ^b, Alicia Le Bras ^b, Joana Oliveira ^a, Amelia Favier ^a, Jeremy Belghiti ^a, Catherine Uzan ^a,^c,^d, Isabelle Durand-Zaleski ^b,^e,^f, Geoffroy Canlorbe ^a,^c,^d,^⁎
^a Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Surgery and Oncological Gynecology, Pitié-Salpêtrière University Hospital, Paris, France
^b DRCI-URC Eco Ile-de-France (AP-HP), Assistance Publique-Hôpitaux de Paris, Paris, France
^c University Institute of Cancerology, AP–HP, Sorbonne University, Paris, France
^d Saint-Antoine Research Center, INSERM UMR_S_938, Cancer Biology and Therapeutics, Sorbonne University, Paris, France
^e Assistance Publique-Hôpitaux de Paris, Department of Public Health, Henri Mondor-Albert-Chenevier, Créteil, France
^f CRESS, INSERM, INRA, University of Paris, Paris, France
^g Intercommunal Hospital Center André Grégoire, Montreuil, France

^⁎Corresponding author at: Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Surgery and Oncological Gynecology, Pitié-Salpêtrière University Hospital - Charles Foix, 47/83 boulevard de l'Hôpital 75013 Paris, France.Assistance Publique des Hôpitaux de Paris (AP-HP)Department of Surgery and Oncological GynecologyPitié-Salpêtrière University Hospital - Charles Foix47/83 boulevard de l'HôpitalParis75013France

Highlights

•	What is already known about the topic?Robot assisted surgery for benign hysterectomies is booming last few years with an improvement in terms of ergonomics for the surgeon compared with laparoscopy, but without any scientific validation in terms of efficiency, and at a significant additional cost.
•	What does the paper add to existing knowledge?This study is the first French study to analyse the medico-economic robotic surgery compared with laparoscopic approaches. This study provides cost-effectiveness estimates of robotic surgery for benign hysterectomies taking into account intra- and post-operative complications as well as human and material costs, compared with laparoscopy.
•	What insights does the paper provide for informing healthcare-related decision making?For now, robotic surgery for benign hysterectomy is more expensive than laparoscopy with an additional cost of € 377,534 per major postoperative complication avoided, but this additional cost could decrease in the years to come with a decline in the material costs of the robot, a reduction in operating time and an increase in outpatient surgery, making the robot more cost-effectiveness than laparoscopy.

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Abstract

Background

Hysterectomy for benign pathologies is one of the most common gynecological surgeries. In recent years, robotic surgery has become an alternative to traditional surgery, but at a higher cost.

Objective

Estimate the cost of benign robot-assisted hysterectomy for the purpose of supporting public decision-making, as well as the additional cost per major postoperative complication (ClavienDindo score ≥ 3) avoided one month after surgery robotic versus traditional laparoscopic.

Methods

Single-center retrospective study including patients operated on for benign hysterectomy at La Pitié Salpêtrière hospital between January 2016 and December 2019: 99 by robotic approach, and 86 by laparoscopic approach. Comparison of robotic surgery to laparoscopy. Calculation of a cost-effectiveness ratio (ICER). Use of the propensity score inverse weighting method to ensure comparability of groups.

Results

Robotic surgery has a total cost of € 6,615 at 1 month per patient compared to € 3,859 for laparoscopic surgery with an additional cost of € 377,534 per major postoperative complication avoided, longer operating time and an absence of significant difference in terms of complications and length of hospitalization.

Conclusion

In terms of cost-effectiveness, according to this study, the robot does not appear to be better than laparoscopy. In the years to come, we can expect a development of robotic surgery with rationalization of the practice, with appropriate selection of patients for robotic surgery, development of outpatient surgery and a reduction in the cost of the equipment.

Le texte complet de cet article est disponible en PDF.

Keywords : Hysterectomy, Robot-assisted laparoscopy, Laparoscopy, Cost, Cost effectiveness