title: Comparative cost-effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of men with localised prostate cancer: a health technology assessment from the perspective of the UK National Health Service.
abstract: BACKGROUND
  Robot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs.
  
  
  OBJECTIVE
  To determine the cost-effectiveness of robotic prostatectomy.
  
  
  METHODS
  We conducted a care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. We used data from a meta-analysis, other published literature, and costs from the UK National Health Service and commercial sources.
  
  
  METHODS
  Care received by men for 10 yr following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually.
  
  
  CONCLUSIONS
  Over 10 yr, robotic prostatectomy was on average (95% confidence interval [CI]) £1412 (€1595) (£1304 [€1473] to £1516 [€1713]) more costly than laparoscopic prostatectomy but more effective with mean (95% CI) gain in quality-adjusted life-years (QALYs) of 0.08 (0.01-0.15). The incremental cost-effectiveness ratio (ICER) was £18 329 (€20 708) with an 80% probability that robotic prostatectomy was cost effective at a threshold of £30 000 (€33 894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy.
  
  
  CONCLUSIONS
  Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data.
authors.affiliation: School of Biology, Newcastle University, Newcastle upon Tyne, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Close
authors.forename: Clare
authors.initials: C
authors.lastname: Robertson
authors.forename: Stephen
authors.initials: S
authors.lastname: Rushton
authors.forename: Mark
authors.initials: M
authors.lastname: Shirley
authors.forename: Luke
authors.initials: L
authors.lastname: Vale
authors.forename: Craig
authors.initials: C
authors.lastname: Ramsay
authors.forename: Robert
authors.initials: R
authors.lastname: Pickard
mesh_terms: D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D006302:Health Services Research; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D018803:Models, Economic; D010043:Outcome and Process Assessment, Health Care / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics / Q000628:therapy; D011468:Prostatectomy / Q000009:adverse effects / Q000191:economics* / Q000379:methods; D011471:Prostatic Neoplasms / Q000191:economics* / Q000601:surgery*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012371:Robotics / Q000191:economics*; D013222:State Medicine / Q000191:economics*; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000191:economics*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
keywords: Cost-effectiveness analysis; Laparoscopic surgery; Prostate cancer; Robotic surgery