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Randomized Controlled Trial
. 2023 Dec 1;278(6):841-849.
doi: 10.1097/SLA.0000000000006073. Epub 2023 Aug 8.

Robotic Lobectomy Is Cost-effective and Provides Comparable Health Utility Scores to Video-assisted Lobectomy: Early Results of the RAVAL Trial

Yogita S Patel  1 , Jean-Marc Baste  2 , Yaron Shargall  1 , Thomas K Waddell  3 , Kazuhiro Yasufuku  3 , Tiago N Machuca  4 , Feng Xie  5 , Lehana Thabane  5 , Waël C Hanna  1
Affiliations
Randomized Controlled Trial

Robotic Lobectomy Is Cost-effective and Provides Comparable Health Utility Scores to Video-assisted Lobectomy: Early Results of the RAVAL Trial

Yogita S Patel et al. Ann Surg. .

Abstract

Objective: The aim of this study was to determine if robotic-assisted lobectomy (RPL-4) is cost-effective and offers improved patient-reported health utility for patients with early-stage non-small cell lung cancer when compared with video-assisted thoracic surgery lobectomy (VATS-lobectomy).

Background: Barriers against the adoption of RPL-4 in publicly funded health care include the paucity of high-quality prospective trials and the perceived high cost of robotic surgery.

Methods: Patients were enrolled in a blinded, multicentered, randomized controlled trial in Canada, the United States, and France, and were randomized 1:1 to either RPL-4 or VATS-lobectomy. EuroQol 5 Dimension 5 Level (EQ-5D-5L) was administered at baseline and postoperative day 1; weeks 3, 7, 12; and months 6 and 12. Direct and indirect costs were tracked using standard methods. Seemingly Unrelated Regression was applied to estimate the cost effect, adjusting for baseline health utility. The incremental cost-effectiveness ratio was generated by 10,000 bootstrap samples with multivariate imputation by chained equations.

Results: Of 406 patients screened, 186 were randomized, and 164 analyzed after the final eligibility review (RPL-4: n=81; VATS-lobectomy: n=83). Twelve-month follow-up was completed by 94.51% (155/164) of participants. The median age was 68 (60-74). There were no significant differences in body mass index, comorbidity, pulmonary function, smoking status, baseline health utility, or tumor characteristics between arms. The mean 12-week health utility score was 0.85 (0.10) for RPL-4 and 0.80 (0.19) for VATS-lobectomy ( P =0.02). Significantly more lymph nodes were sampled [10 (8-13) vs 8 (5-10); P =0.003] in the RPL-4 arm. The incremental cost/quality-adjusted life year of RPL-4 was $14,925.62 (95% CI: $6843.69, $23,007.56) at 12 months.

Conclusion: Early results of the RAVAL trial suggest that RPL-4 is cost-effective and associated with comparable short-term patient-reported health utility scores when compared with VATS-lobectomy.

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Conflict of interest statement

W.C.H.: advisory board and speakers bureau for Astra Zeneca, data safety monitoring committee for Roche/Genentech, speakers bureau for Minogue Medical, grant funding from Intuitive Surgical. The remaining authors report no conflicts of interest.

References

    1. Louie BE, Wilson JL, Kim S, et al. Comparison of video-assisted thoracoscopic surgery and robotic approaches for clinical stage I and stage II non-small cell lung cancer using the Society of Thoracic Surgeons Database. Ann Thorac Surg. 2016;102:917–924.
    1. Kneuertz PJ, Singer E, D’Souza DM, et al. Hospital cost and clinical effectiveness of robotic-assisted versus video-assisted thoracoscopic and open lobectomy: a propensity score-weighted comparison. J Thorac Cardiovasc Surg. 2019;157:2018–2026.e2.
    1. Lampridis S, Maraschi A, Le Reun C, et al. Robotic versus video-assisted thoracic surgery for lung cancer: short-term outcomes of a propensity matched analysis. Cancers (Basel). 2023;15:2391.
    1. Cerfolio R, Louie BE, Farivar AS, et al. Consensus statement on definitions and nomenclature for robotic thoracic surgery. J Thorac Cardiovasc Surg. 2017;154:1065–1069.
    1. Cerfolio RJ, Bryant AS. How to teach robotic pulmonary resection. Semin Thorac Cardiovasc Surg. 2013;25:76–82.

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