Economic evaluation of robotic and laparoscopic paraesophageal hernia repair

• Published in: Surgical endoscopy Vol. 37; no. 9; pp. 6806 - 6817
• Main Authors: Panse, Neal S., Prasath, Vishnu, Quinn, Patrick L., Chokshi, Ravi J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.09.2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Aged; Cost analysis; Cost-Benefit Analysis; Gastroenterology; Gynecology; Hepatology; Hernia, Hiatal - surgery; Hernias; Herniorrhaphy - methods; Humans; Laparoscopy; Laparoscopy - methods; Maintenance costs; Medicare; Medicine; Medicine & Public Health; Proctology; Robotic surgery; Robotic Surgical Procedures - methods; Secondary analysis; Sensitivity analysis; Surgery; United States; United States; Robotic surgery; Foregut surgery; Laparoscopy; Paraesophageal hernia; Cost analysis; Cost-effectiveness
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-023-10119-5

Background Robotic approach in paraesophageal hernia (PEH) repair may improve outcomes over laparoscopic approach, though at additional cost. This study aimed to compare cost-effectiveness of robotic and laparoscopic PEH repair. Methods A decision tree was created analyzing cost-effectiveness of robotic and laparoscopic PEH repair. Costs were obtained from 2021 Medicare data and were accumulated within 60 months after surgery. Effectiveness was measured in quality-adjusted life-years (QALYs). Branch-point probabilities and costs of robotic surgery consumables were obtained from published literature. The primary outcome of interest was incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were performed. A secondary analysis including attributable capital and maintenance costs of robotic surgery was conducted as well. Results Laparoscopic repair yielded 3.660 QALYs at $35,843.82. Robotic repair yielded 3.661 QALYs at $36,342.57, with an ICER of $779,488.62/QALY. Robotic repair was favored when rates of open conversion and symptom recurrence were low, or with reduced cost of robotic instruments. A probabilistic sensitivity analysis favored laparoscopic repair in 100% of simulations. When accounting for costs of robotic technology, robotic approach was preferred only in unrealistic clinical scenarios. Conclusions Laparoscopic repair is likely more cost-effective for most institutions, though results were relatively similar. With experienced surgeons who surpass the initial learning curve, robotic surgery may improve outcomes enough to be cost-effective, but only when excluding capital and maintenance fees.