Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study.
Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA).



The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches.



The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p < 0.001). The study showed no significant difference in total costs between OS and DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p < 0.001), but not against DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge.



The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.
Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127, Pisa, Italy. g.turchetti@sssup.it.
Giuseppe
G
Turchetti
Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127, Pisa, Italy.
Francesca
F
Pierotti
Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127, Pisa, Italy.
Ilaria
I
Palla
Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, 56127, Pisa, Italy.
Stefania
S
Manetti
EndoCAS Center, University of Pisa, Pisa, Italy.
Cinzia
C
Freschi
EndoCAS Center, University of Pisa, Pisa, Italy.
Vincenzo
V
Ferrari
Institute for Medical Science and Technology, University of Dundee, Dundee, Scotland, UK.
Alfred
A
Cuschieri
D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000191:economics* / Q000379:methods; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D065287:Robotic Surgical Procedures / Q000191:economics* / Q000379:methods; D013673:Technology Assessment, Biomedical
Economic evaluation in health care; Economics of innovation; Health technology assessment; Robotic surgery; da Vinci