Economic evaluation of robot-assisted hysterectomy: a cost-minimisation analysis

Abstract

Objective: The aim of this study was to carry out an economic evaluation of robot-assisted hysterectomy compared with the current standard of care in Ireland.

Design: Cost-minimisation analysis of robot-assisted hysterectomy compared with a combination of traditional open and conventional laparoscopic surgery.

Setting: The publicly funded healthcare system in Ireland.

Population: The target population was women requiring hysterectomy that could be completed using robot-assisted surgery.

Methods: A simulation-based economic evaluation model including data derived from a systematic review and local databases was used to estimate surgical costs.

Main outcome measures: Incremental cost of robot-assisted surgery compared to current routine care.

Results: The incremental cost of robot-assisted hysterectomy is an estimated €3291 (95% confidence interval €2509-€4183) more than the existing mix of open and traditional laparoscopic surgery. The additional cost of robot-assisted surgery is primarily driven by the increased cost of surgical equipment, the robot, maintenance of the robot, and the cost of theatre staff due to longer operative times. The only significant factor reducing the cost of surgery is a shorter hospital stay relative to open surgery.

Conclusions: Robot-assisted hysterectomy is more costly than the current mix of open and traditional laparoscopic surgery. Without longer-term or functional outcome data, the additional expense associated with robot-assisted hysterectomy may not be justified in a budget-constrained health system.

Keywords: Economic evaluation; hysterectomy; robot-assisted.