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

Area of Science:

• Urology
• Health Economics
• Surgical Oncology

Background:

• The cost-effectiveness of radical prostatectomy techniques is debated, necessitating updated analyses.
• Changes in surgical equipment costs and clinical data require re-evaluation in the UK's National Health Service (NHS).
• Centralized, government-funded healthcare systems require specific cost-effectiveness assessments.

Purpose of the Study:

• To compare the cost-effectiveness of robotic-assisted radical prostatectomy (RARP) versus open (ORP) and laparoscopic (LRP) radical prostatectomy.
• To utilize contemporary UK data on clinical outcomes, costs, and surgical volumes for the comparison.
• To assess treatment options for localized prostate cancer within the UK healthcare system.

Main Methods:

• A Markov model was employed for economic analysis, comparing RARP, LRP, and ORP.
• The model simulated 65-year-old men with localized prostate cancer over a 10-year follow-up period.
• Data were analyzed from May 2020 to July 2021 from a UK NHS perspective.

Main Results:

• RARP was dominant over LRP, costing less (£1785) with more quality-adjusted life-years (QALYs) gained (0.24).
• RARP demonstrated a favorable incremental cost-effectiveness ratio (ICER) of £4293/$5653 per QALY compared to ORP, below the £30,000/$39,503 willingness-to-pay threshold.
• Lower risk of biochemical recurrence (BCR) was the most sensitive factor influencing RARP's cost-effectiveness.

Conclusions:

• RARP is likely a cost-effective surgical option for localized prostate cancer in the UK compared to ORP and LRP.
• The cost-effectiveness of RARP is primarily driven by its reduced risk of biochemical recurrence.
• Findings may vary in different healthcare settings due to differing cost structures and willingness-to-pay thresholds.