Cost-effectiveness of robot-assisted total hysterectomy for benign pathologies compared to open surgery: a...

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

Calculate the cost-effectiveness of robot-assisted hysterectomy (RAH) compared with open hysterectomy (OH) 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 open surgery.

Single-center retrospective study including patients operated on for benign hysterectomy at La Pitié Salpêtrière hospital between January 2016 and December 2019: 24 by robotic approach, and 54 by open surgery. Comparison of robotic surgery to open. Calculation of a cost-effectiveness ratio (ICER). Use of the propensity score inverse weighting method to ensure comparability of groups.

Robotic surgery has a total cost of €7704 at 1 month per patient compared to €5301 for open surgery with an additional cost of € 828,621 per major postoperative complication avoided, longer operating time and an absence of significant difference in terms of complications and length of hospitalization.

In terms of cost-effectiveness, RAH had a high probability to be more expensive and more effective than OH. 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.