Comparison of robotic versus laparoscopic versus open distal gastrectomy for locally advanced gastric cancer: a prospective trial-based economic evaluation

• Published in: Surgical endoscopy Vol. 37; no. 10; pp. 7472 - 7485
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Cost analysis; CT0; CT01609309; Economics; Gastric cancer; Gastroenterology; Gastrointestinal surgery; Gynecology; Hepatology; Laparoscopy; Medicine; Medicine & Public Health; NCT; NCT03313700; Proctology; Robotic surgery; Sensitivity analysis; Surgery; Gastrectomy; Cost-effectiveness; Gastric cancer; Robotic
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-023-10147-1

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).