机器人辅助手术随机试验中的成本分析:系统性审查
Sterre R J Bosscha1,2, Rawin Amiri1,2, Faridi Jamaludin1,2
1Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, the Netherlands.
BJS open
|January 28, 2026
概括
在随机临床试验 (RCT) 中,机器人辅助手术 (RAS) 成本分析往往不足,存在高偏差风险和不完整的报告. 改进的经济评估对于了解RAS的成本效益至关重要.
科学领域:
- 卫生经济学 卫生经济学
- 手术创新 在外科创新.
- 临床试验方法论 临床试验方法论
背景情况:
- 机器人辅助手术 (RAS) 的采用正在增加,但其成本效益仍在争论中.
- 强大的成本分析对于评估RAS至关重要,但存在重大挑战.
- 本系统性审查评估了随机临床试验 (RCT) 中成本分析的质量,将RAS与替代手术方法进行比较.
研究的目的:
- 系统地评估RCT成本分析的方法质量和全面性,将RAS与其他外科手术方法进行比较.
- 在RAS的经济评估中发现常见的偏见和报告缺陷.
- 突出在RAS研究中需要标准化的经济评估.
主要方法:
- 在PubMed,EMBASE,Cochrane图书馆和Web of Science进行了系统的文献搜索,截至2025年8月.
- 包括RCT与RAS与替代方法进行比较,并包括成本分析.
- 对包括的研究进行了偏差风险,方法质量 (ECOBIAS) 和报告全面性 (CHEERS) 的评估.
主要成果:
- 审查了38项涉及5832名患者的RCT,主要涉及整体外科,泌尿病学和妇科.
- 在26%的研究中发现了显著的偏差风险,其中63%的人有一些担忧.
- 平均而言,研究仅符合5/11的ECOBIAS标准和14/28的CHEERS项目,并且对结构性和组件特定的RAS成本的报告不完全. 92%的研究发现RAS更昂贵.
结论:
- 将RAS与替代手术方法进行比较的RCT经常缺乏足够的成本评估和成本效益分析.
- 实质性的偏见,方法异质性和不完整的成本报告需要在RAS RCT中统一的经济评估标准.
- 标准化的经济评估对于在临床实践中准确评估RAS值至关重要.
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