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Cost-effectiveness of robotic-assisted surgery vs open surgery in the context of partial nephrectomy for small kidney tumors

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Abstract

To evaluate the cost-effectiveness of robotic-assisted surgery compared to open surgery in the context of partial nephrectomy for small kidney tumor management. This is a retrospective study using data from 395 patients operated on by either robot-assisted surgery (RAPN) or by open partial nephrectomy (OPN); one hospital performed RAPN exclusively and the second hospital, OPN exclusively. Cost-effectiveness analysis was conducted from the perspective of the National Health Insurance System (NHIS) by considering the costs of the initial hospital stay and the cost of complications. Clinical outcome was defined by the avoidance of major complications during the 12 months postoperatively. Major complications were absent in 82% of patients in the OPN group and 93% of patients in the RAPN group, with 11% in favor of robotic assistance (p < 0.001). The average cost per patient, including the costs of complications, were, respectively, 9637 € and 8305 € for the OPN and RAPN groups. Robotic assistance was associated with a 1332 € lower cost (p < 0.001). The incremental cost-effectiveness ratio (ICER) is estimated at − 12,039 €. From the perspective of the public payer, robotic assistance was associated with a lower rate of postoperative complications and a lower average cost per patient. Robotic-assisted surgery was an efficient alternative to open surgery in partial nephrectomy. Trial registration number: NCT05089006 (October 22, 2021).

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Data availability

The data that support the findings of this study are available from Délégation à la Recherche Clinique et à l’Innovation (DRCI), Nancy University Hospital (cci@chru-nancy.fr).

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Acknowledgements

Délégation à la Recherche Clinique et à l’Innovation (DRCI), Centre Hospitalier Régional Universitaire de Nancy.

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Authors and Affiliations

  1. Urology Department, Nancy University Hospital, Site de Brabois, rue du Morvan, Vandœuvre-lès-Nancy, France

    Adnan Baghli, Pascal Eschwege, Jacques Hubert & Charles Mazeaud

  2. Urology Department, University Hospital of Reims, Robert Debré Site, Reims, France

    Victor Audigé & Stéphane Larré

  3. Centre for Clinical Epidemiology CIC 1433 Inserm, Nancy University Hospital, Site de Brabois, Nancy, France

    Hamza Achit

  4. Trenel Urology Center, Trenel Clinic, Sainte Colombe, France

    Benjamin Branchu

  5. Clinical Epidemiology, Paris-Saclay University, UVSQ, Inserm, CESP, Villejuif, France

    Beverley Balkau

Authors
  1. Adnan Baghli
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  2. Hamza Achit
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  3. Victor Audigé
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  4. Stéphane Larré
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  5. Benjamin Branchu
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  6. Beverley Balkau
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  7. Pascal Eschwege
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  8. Jacques Hubert
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  9. Charles Mazeaud
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Contributions

AB: manuscript writing, data collection, data management, data analysis, protocol development, and project development. HA: manuscript writing, data analysis, and protocol development. VA: data collection and data analysis. SL: project development. BB: data analysis and project development. BB: manuscript writing. PE: project development. J Hubert: protocol development and data management. CM: data management and protocol development.

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Correspondence to Adnan Baghli.

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Baghli, A., Achit, H., Audigé, V. et al. Cost-effectiveness of robotic-assisted surgery vs open surgery in the context of partial nephrectomy for small kidney tumors. J Robotic Surg 17, 1571–1578 (2023). https://doi.org/10.1007/s11701-023-01552-8

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  • DOI: https://doi.org/10.1007/s11701-023-01552-8

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