A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy

Area of Science:

• Urology
• Surgical Oncology
• Health Economics

Background:

• Radical prostatectomy (RP) is a primary treatment for localized prostate cancer.
• Robot-assisted laparoscopic prostatectomy (RALP) and retropubic radical prostatectomy (RRP) are surgical options.
• Evaluating the cost-effectiveness and cost utility of these procedures is crucial for healthcare decision-making.

Purpose of the Study:

• To compare the cost-effectiveness and cost utility of RALP versus RRP.
• To determine the incremental cost-effectiveness ratio (ICER) per successful treatment and per quality-adjusted life-year (QALY).

Main Methods:

• Retrospective cohort study of 231 men aged 50-69 with localized prostate cancer.
• Matched 1:2 comparison of 77 RALP patients and 154 RRP patients based on age and D'Amico risk classification.
• Economic evaluation of direct costs in the first postoperative year and sensitivity analysis.

Main Results:

• RALP demonstrated a 7% higher effectiveness compared to RRP.
• The ICER per extra successful treatment was €64,343 for RALP (direct costs) and €13,514 (indirect costs).
• No significant QALY gain was observed for RALP at 1 year, though data was incomplete.

Conclusions:

• RALP is more effective but also more costly than RRP.
• Improving RALP cost-effectiveness may involve centralizing procedures at high-volume urology centers.
• Study limitations include missing data on erectile dysfunction medication and short-term quality of life assessment.