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Cost-effectiveness of robot-assisted total hysterectomy for benign pathologies compared to laparoscopic surgery: A
Richard Paul-Dehlinger1, Alexandra Vappereau2, Alicia Le Bras2
1Assistance Publique des Hôpitaux de Paris (AP-HP), Department of Surgery and Oncological Gynecology, Pitié-Salpêtrière University Hospital, Paris, France; Intercommunal Hospital Center André Grégoire, Montreuil, France.
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.
