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Observational Study
. 2024 Nov;38(11):6270-6281.
doi: 10.1007/s00464-024-11109-x. Epub 2024 Aug 13.

Cost-effectiveness of robotic vs laparoscopic distal pancreatectomy. Results from the national prospective trial ROBOCOSTES

María Alejandra Guerrero-Ortiz  1 , Patricia Sánchez-Velazquez  1 , Fernando Burdío  1 , Marta Gimeno  1 , Mauro Podda  2 , Gianluca Pellino  3 , Miguel Toledano  4 , Javier Nuñez  5 , Juan Bellido  6 , María Asunción Acosta-Mérida  7 , Emilio Vicente  8 , Santiago Lopez-Ben  9 , David Pacheco  4 , Elizabeth Pando  3 , Rosa Jorba  10 , Juan Pablo Arjona Trujillo  11 , Fabio Ausania  12 , Mario Alvarez  13 , Nair Fernandes  3 , Sandra Castro-Boix  3 , Amaia Gantxegi  3 , Miquel Kraft- Carré  3 , Pilar Pinto-Fuentes  4 , Alejandro Bueno-Cañones  4 , Javier Valdes-Hernandez  6 , Luis Tresierra  7   14 , Riccardo Caruso  8 , Valentina Ferri  8 , Berta Tio  9 , Sonia Babiloni-Simon  10 , David Lacasa-Martin  11 , Carolina González-Abós  12 , Jenny Guevara-Martinez  13 , Eduardo Gutierrez-Iscar  13 , Raquel Sanchez-Santos  15 , Oscar Cano-Valderrama  15 , Manuel Nogueira-Sixto  15 , Nicolas Alvarez-Garrido  15 , Sagrario Martinez-Cortijo  16 , Manuel Alberto Lasaia  16 , Santiago Linacero  16 , Ana Pilar Morante  16 , Fernando Rotellar  17 , Jorge Arredondo  17 , Pablo Marti  17 , Lucas Sabatella  17 , Gabriel Zozaya  17 , Benedetto Ielpo  18
Affiliations
Observational Study

Cost-effectiveness of robotic vs laparoscopic distal pancreatectomy. Results from the national prospective trial ROBOCOSTES

María Alejandra Guerrero-Ortiz et al. Surg Endosc. 2024 Nov.

Erratum in

  • Correction: Cost-efectiveness of robotic vs laparoscopic distal pancreatectomy. Results from the national prospective trial ROBOCOSTES.
    Guerrero-Ortiz MA, Sánchez-Velazquez P, Burdío F, Gimeno M, Podda M, Pellino G, Toledano M, Nuñez J, Bellido J, Acosta-Mérida MA, Vicente E, Lopez-Ben S, Pacheco D, Pando E, Jorba R, Trujillo JPA, Ausania F, Alvarez M, Fernandes N, Castro-Boix S, Gantxegi A, Carré MK, Pinto-Fuentes P, Bueno-Cañones A, Valdes-Hernandez J, Tresierra L, Caruso R, Ferri V, Tio B, Babiloni-Simon S, Lacasa-Martin D, González-Abós C, Guevara-Martinez J, Gutierrez-Iscar E, Sanchez-Santos R, Cano-Valderrama O, Nogueira-Sixto M, Alvarez-Garrido N, Martinez-Cortijo S, Lasaia MA, Linacero S, Morante AP, Rotellar F, Arredondo J, Marti P, Sabatella L, Zozaya G, Ielpo B. Guerrero-Ortiz MA, et al. Surg Endosc. 2024 Nov;38(11):6982-6984. doi: 10.1007/s00464-024-11312-w. Surg Endosc. 2024. PMID: 39347962 No abstract available.

Abstract

Introduction: Although several studies report that the robotic approach is more costly than laparoscopy, the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) is still an issue. This study evaluates the cost-effectiveness of the RDP and LDP approaches across several Spanish centres.

Methods: This study is an observational, multicenter, national prospective study (ROBOCOSTES). For one year from 2022, all consecutive patients undergoing minimally invasive distal pancreatectomy were included, and clinical, QALY, and cost data were prospectively collected. The primary aim was to analyze the cost-effectiveness between RDP and LDP.

Results: During the study period, 80 procedures from 14 Spanish centres were analyzed. LDP had a shorter operative time than the RDP approach (192.2 min vs 241.3 min, p = 0.004). RDP showed a lower conversion rate (19.5% vs 2.5%, p = 0.006) and a lower splenectomy rate (60% vs 26.5%, p = 0.004). A statistically significant difference was reported for the Comprehensive Complication Index between the two study groups, favouring the robotic approach (12.7 vs 6.1, p = 0.022). RDP was associated with increased operative costs of 1600 euros (p < 0.031), while overall cost expenses resulted in being 1070.92 Euros higher than the LDP but without a statistically significant difference (p = 0.064). The mean QALYs at 90 days after surgery for RDP (0.9534) were higher than those of LDP (0.8882) (p = 0.030). At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was a 62.64% and 71.30% probability that RDP was more cost-effective than LDP, respectively.

Conclusions: The RDP procedure in the Spanish healthcare system appears more cost-effective than the LDP.

Keywords: Cost-effectiveness analysis; Laparoscopic distal pancreatectomy; Minimally invasive surgery; Quality of life analysis; Robotic distal pancreatectomy.

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