A systematic review and cost analysis of robot-assisted hysterectomy in malignant and benign conditions.
In order to assess the effectiveness and costs of robot-assisted hysterectomy compared with conventional techniques we reviewed the literature separately for benign and malignant conditions, and conducted a cost analysis for different techniques of hysterectomy from a hospital economic database. Unlimited systematic literature search of Medline, Cochrane and CRD databases produced only two randomized trials, both for benign conditions. For the outcome assessment, data from two HTA reports, one systematic review, and 16 original articles were extracted and analyzed. Furthermore, one cost modelling and 13 original cost studies were analyzed. In malignant conditions, less blood loss, fewer complications and a shorter hospital stay were considered as the main advantages of robot-assisted surgery, like any mini-invasive technique when compared to open surgery. There were no significant differences between the techniques regarding oncological outcomes. When compared to laparoscopic hysterectomy, the main benefit of robot-assistance was a shorter learning curve associated with fewer conversions but the length of robotic operation was often longer. In benign conditions, no clinically significant differences were reported and vaginal hysterectomy was considered the optimal choice when feasible. According to Finnish data, the costs of robot-assisted hysterectomies were 1.5-3 times higher than the costs of conventional techniques. In benign conditions the difference in cost was highest. Because of expensive disposable supplies, unit costs were high regardless of the annual number of robotic operations. Hence, in the current distribution of cost pattern, economical effectiveness cannot be markedly improved by increasing the volume of robotic surgery.
Department of Gynecology and Pediatrics, Helsinki University Hospital, HUCH, Finland. Electronic address: anna-maija.tapper@hus.fi.
Anna-Maija
AM
Tapper
Pirkanmaa Hospital District, Finland. Electronic address: mikko.hannola@pshp.fi.
Mikko
M
Hannola
Tampere University Hospital, Finland. Electronic address: rainer.zeitlin@pshp.fi.
Rainer
R
Zeitlin
Finohta (Finnish Office for Health Technology)/National Institute for Health and Welfare (THL), Finland. Electronic address: jaana.isojarvi@thl.fi.
Jaana
J
Isojärvi
Hjelt Institute/Department of Public Health, University of Helsinki, Finland. Electronic address: harri.sintonen@helsinki.fi.
Harri
H
Sintonen
Finohta (Finnish Office for Health Technology)/National Institute for Health and Welfare (THL), Hospital District of Southwest Finland, PB 52, 20521 Turku, Finland. Electronic address: tuija.ikonen@tyks.fi.
Tuija S
TS
Ikonen
D016063:Blood Loss, Surgical; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000191:economics* / Q000295:instrumentation / Q000379:methods*; D007045:Hysterectomy, Vaginal / Q000191:economics / Q000379:methods; D010535:Laparoscopy / Q000191:economics; D007902:Length of Stay / Q000191:economics; D061646:Operative Time; D065287:Robotic Surgical Procedures / Q000191:economics*; D012371:Robotics / Q000191:economics; D014594:Uterine Neoplasms / Q000601:surgery*
Benign conditions of uterus; Cost analysis; Laparoscopic hysterectomy; Malignant disease of uterus; Robot-assisted hysterectomy; Vaginal hysterectomy