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Multicenter Study
. 2024 Oct;38(10):5881-5890.
doi: 10.1007/s00464-024-10849-0. Epub 2024 Aug 20.

Nationwide cost-effectiveness and quality of life analysis of minimally invasive distal pancreatectomy

Matteo De Pastena  1 , Alessandro Esposito  1 , Salvatore Paiella  1 , Greta Montagnini  1 , Caterina C Zingaretti  1 , Marco Ramera  1   2 , Danila Azzolina  3 , Dario Gregori  4 , Emanuele F Kauffmann  5 , Alessandro Giardino  6 , Luca Moraldi  7 , Giovanni Butturini  6 , Ugo Boggi  5 , Roberto Salvia  8   9
Affiliations
Multicenter Study

Nationwide cost-effectiveness and quality of life analysis of minimally invasive distal pancreatectomy

Matteo De Pastena et al. Surg Endosc. 2024 Oct.

Abstract

Background: This study analyzed the Quality of Life (QoL) and cost-effectiveness of laparoscopic (LDP) versus robotic distal pancreatectomy (RDP).

Methods: Consecutive patients submitted to LDP or RDP from 2010 to 2020 in four high-volume Italian centers were included, with a minimum of 12 months of postoperative follow-up were included. QoL was evaluated using the EORTC QLQ-C30 and EQ-5D questionnaires, self-reported by patients. After a propensity score matching, which included BMI, gender, operation time, multiorgan and vascular resections, splenic preservation, and pancreatic stump management, the mean differential cost and Quality-Adjusted Life Years (QALY) were calculated and plotted on a cost-utility plane.

Results: The study population consisted of 564 patients. Among these, 271 (49%) patients were submitted to LDP, while 293 (51%) patients to RDP. After propensity score matching, the study population was composed of 159 patients in each group, with a median follow-up of 59 months. As regards the QoL analysis, global health and emotional functioning domains showed better results in the RDP group (p = 0.037 and p = 0.026, respectively), whereas the other did not differ. As expected, the median crude costs analysis confirmed that RDP was more expensive than LDP (16,041 Euros vs. 10,335 Euros, p < 0.001). However, the robotic approach had a higher probability of being more cost-effective than the laparoscopic procedure when a willingness to pay more than 5697 Euros/QALY was accepted.

Conclusion: RDP was associated with better QoL as explored by specific domains. Crude costs were higher for RDP, and the cost-effectiveness threshold was set at 5697 euros/QALY.

Keywords: Cost analysis; Laparoscopic distal pancreatectomy; Minimally invasive pancreatectomy; Pancreatic surgery; Robotic distal pancreatectomy.

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Conflict of interest statement

Matteo De Pastena, Alessandro Esposito, Greta Montagnini, Caterina C. Zingaretti, Marco Ramera, Danila Azzolina, Dario Gregori, Emanuele F. Kauffmann, Alessandro Giardino, Luca Moraldi, Giovanni Butturini, Ugo Boggi, Roberto Salvia have no conflicts of interest or financial ties to disclose. Salvatore Paiella received consultancy honoraria from AlphaTau.

Figures

Fig. 1
Fig. 1
The propensity score matching plot. The study population consisted of 418 patients, 209 each group
Fig. 2
Fig. 2
The cost-effectiveness plane. ICER slope was 5691 Euros (95% CI 1785–17,916 Euros)
Fig. 3
Fig. 3
The expected incremental benefit (EIB) plot. The willingness to pay (WTP) was 5697 Euros
Fig. 4
Fig. 4
The cost-effectiveness acceptability curve (CEAC). The CEAC demonstrated that the robotic approach had a higher probability of being more cost-effective than the laparoscopic procedure when a WTP of at least 5697 Euros/QALY was accepted
Fig. 5
Fig. 5
The Quality of Life analysis demonstrated a significant improvement in the RDP group in the global health (GH) and emotional functioning (EF) domains (p = 0.037 and p = 0.026, respectively)
See this image and copyright information in PMC

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