Comparison of robotic versus laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a prospective trial-based economic evaluation.
In: Surgical Endoscopy & Other Interventional Techniques, Jg. 37 (2023-10-01), Heft 10, S. 7472-7485
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Zugriff:
Importance: It is largely unclear whether robotic distal gastrectomy (RDG) is cost-effective for locally advanced gastric cancer (LAGC). Objective: To evaluate the cost-effectiveness of RDG, laparoscopic distal gastrectomy (LDG), and open distal gastrectomy (ODG) for patients with LAGC. Design, setting, and participants: Inverse probability of treatment weighting (IPTW) was used to balance baseline characteristics. A decision-analytic model was constructed to evaluate the cost-effectiveness of RDG, LDG, and ODG. Exposures: RDG, LDG, and ODG. Main outcomes and measures: Incremental cost-effectiveness ratio (ICER) and quality-adjusted life year (QALY). Results: This pooled analysis of two randomized controlled trials included 449 patients: 117, 254, and 78 patients in the RDG, LDG, and ODG groups, respectively. After IPTW, RDG demonstrated its priority in terms of less blood loss, postoperative length, and complication rate (all P < 0.05). RDG also showed higher QOL with more cost, representing an ICER of $85,739.73 per QALY and $42,189.53 per QALY compared to LDG and ODG, respectively. In probabilistic sensitivity analysis, RDG achieved the best cost-effectiveness for patients with LAGC only when the willingness-to-pay threshold was > $85,739.73 per QALY, which significantly exceeded 3 times Chinese per capita GDP. Furthermore, one of the most important factors was the indirect costs of robotic surgery in terms of the cost-effectiveness of RDG compared to that of LDG or ODG. Conclusions and relevance: Although improved short-term outcomes and QOL were seen in patients underwent RDG, the economic burden should be considered in the clinical decision-making regarding robotic surgery use for patients with LAGC. Our findings may vary in different health care settings and affordability. Trial registration CLASS-01 trial (ClinicalTrials.gov, CT01609309) and FUGES-011 trial (ClinicalTrials.gov, NCT03313700). [ABSTRACT FROM AUTHOR]
Titel: |
Comparison of robotic versus laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a prospective trial-based economic evaluation.
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Autor/in / Beteiligte Person: | Lu, Jun ; Wu, Dong ; Huang, Jiao-bao ; Lin, Jia ; Xu, Bin-bin ; Xue, Zhen ; Zheng, Hua-Long ; Lin, Guo-sheng ; Shen, Li-li ; Li, Ping ; Wang, Jia-Bin ; Lin, Jian-Xian ; Chen, Qi-Yue ; Cao, Long-Long ; Xie, Jian-Wei ; Zheng, Chao-Hui ; Huang, Chang-Ming |
Zeitschrift: | Surgical Endoscopy & Other Interventional Techniques, Jg. 37 (2023-10-01), Heft 10, S. 7472-7485 |
Veröffentlichung: | 2023 |
Medientyp: | academicJournal |
ISSN: | 1866-6817 (print) |
DOI: | 10.1007/s00464-023-10147-1 |
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