Cost-effectiveness of robotic surgery compared to conventional laparoscopy for the management of early-stage cervical cancer: a model-based economic evaluation in China
Objectives
The aim of this study is to assess cost-effectiveness of robotic radical hysterectomy (RRH) vs laparoscopic radical hysterectomy (LRH) in early-stage cervical cancer (ECC).
Design
Model-based cost-effectiveness analysis.
Setting
Based on long-term survival data, a three-state Markov model was constructed using TreeAge Pro 2022 to simulate the possible recurrence of ECC. Data on clinical efficacy and costs were derived from published literature and local databases.
Participants
A hypothetical cohort of 1000 individuals diagnosed with early-stage cervical cancer (FIGO 2009 stages<IIB) who underwent RRH or LRH management.
Outcome measures
The study endpoints were quality-adjusted life years (QALYs), total costs (in Chinese renminbi (RMB) adjusted to 2023-year values using the Consumer Price Index) and incremental cost-effectiveness ratio (ICER). A willingness-to-pay threshold of 268 074 RMB per QALY was used to assess cost-effectiveness.
Results
Robotic group gained more 4.84 QALYs than the laparoscopic group, but total costs for robotic strategy are substantially higher, with the incremental costs of 1 031 108 RMB. The ICER of robotic strategy is 213 054 RMB per QALY. Outcomes were robust in most one-way sensitivity and probabilistic sensitivity analyses.
Conclusions
Robotic strategy is on the efficient frontier but incurs substantial initial cost. Our findings indicated that this strategy is a cost-effective treatment option for ECC patients if assessed over a time horizon of patients’ lifetime. This study underscores the need for long-term clinical trials in early-stage cervical cancer patients with follow-up data that capture financial and quality-of-life end points.