Cost-effectiveness of robotic hysterectomy versus abdominal hysterectomy in early endometrial cancer.

Abstract

OBJECTIVES:

To compare total costs for hospital stay and post-operative recovery between robotic and abdominal hysterectomy in the treatment of early-stage endometrial cancer provided in an enhanced recovery after surgery (ERAS) setting. Costs were evaluated in relation to health impact, taking a societal perspective.

METHODS:

Cost analysis was based on data from an open randomized controlled trial in an ERAS setting at a Swedish tertiary referral university hospital: 50 women with low-risk endometrial cancer scheduled for surgery between February 2012 and May 2016 were included; 25 women were allocated to robotic and 25 to abdominal hysterectomy. We compared the total time in the operating theater, procedure costs, post-operative care, length of hospital stay, readmissions, informal care, and sick leave as well as the health-related quality of life until 6 weeks after surgery. The comparison was made by using the EuroQoL group form with five dimensions and three levels (EQ-5D). The primary outcome measure was total cost; secondary outcomes were quality-adjusted life-years (QALYs) and cost per QALY. The costs were calculated in Swedish Krona (SEK).

RESULTS:

Age (median (IQR) 68 (63-72) vs 67 (59-75) years), duration of hospital stay (ie, time to discharge criteria were met) (median (IQR) 36 (36-36) vs 36 (36-54) hours), and sick leave (median (IQR) 25 (17-30) vs 31 (36-54) days) did not differ between the robotic and abdominal group. Time of surgery was significantly longer in the robotic group than in the abdominal group (median (IQR) 70 (60-90) vs 56 (49-84) min; p<0.05). The robotic group recovered significantly faster as measured by the EQ-5D health index and gained 0.018 QALYs until 6 weeks after surgery. Total costs were 20% higher for the robotic procedure (SEK71 634 vs SEK59 319). The total cost per QALY gained for women in the robotic group was slightly under SEK700 000.

CONCLUSIONS:

Robotic hysterectomy used in an ERAS setting in the treatment of early endometrial cancer improved health within 6 weeks after the operation at a high cost for the health gained compared with abdominal hysterectomy. The productivity loss and informal care were lower for robotic hysterectomy, while healthcare had a higher procedure cost that could not be offset by the higher cost due to complications in the abdominal group.

• Authors: Evelyn Serreyn Lundin, Per Carlsson, Ninnie Borendal Wodlin, Lena Nilsson, Preben Kjölhede
• Journal: International journal of gynecological cancer : official journal of the International Gynecological Cancer Society (Int J Gynecol Cancer) Vol. 30 Issue 11 Pg. 1719-1725 (11 2020) ISSN: 1525-1438 [Electronic] England
• PMID: 32863275 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © IGCS and ESGO 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Aged
• Cost-Benefit Analysis
• Endometrial Neoplasms (surgery)
• Female
• Hospital Costs (statistics & numerical data)
• Humans
• Hysterectomy (economics, methods)
• Length of Stay (economics)
• Middle Aged
• Postoperative Complications (economics)
• Quality-Adjusted Life Years
• Robotic Surgical Procedures (economics, methods)
• Sick Leave (economics)
• Surveys and Questionnaires