Translated Abstract
Objectives:
The primary objectives of this paper were to assess the safety, economical and postoperative efficacy of Da Vinci robotic-assisted radical laparoscopic radical prostatectomy (RALRP) compared with laparoscopic procedures (LRP) from the perspective of health economics, in order to provide advice to hospital policymakers and government decision-makers.
Methods:
Economic data of this study obtained is estimated of RALRP and LRP from two public hospitals in Hangzhou (First Affiliated Hospital of ＂Zhejiang Provinces＂, referred to as ＂Zhejiang University First＂ and Zhejiang Provincial People＇s Hospital, ＂Provincial People＂ for short) during December 2014 to June 2016 using the health economic evaluation methodology, the following methods are mainly used:
1. To calculate the Cost Analysis of RALRP in men with Localized Prostate Cancer from two hospitals of Hangzhou by applying activity-based costing (ABC);
2. Using t-test to compare different clinical efficacy;
3. Creating the decision-tree model to simulate the expected costs and benefits of both RALRP and LRP in the presence or absence of postoperative short-term complications, to perform cost-effectiveness of both procedures. And simultaneous calculation of incremental cost-effectiveness ratio (ICER), is conducted;
4. Sensitivity analysis was performed to estimate the robustness of the outcome.
Results:
1. A total of 800 in men with Localized Prostate Cancer were enrolled in this study; And all patients are safe. Among them, 472 were RALRP patients (197 ＂Provincial People＂ and 275 ＂Zhejiang University First＂) with a mean age of (67.5 ± 7.23), a minimum of 46 years and a maximum of 84 years with a Gleason score of (7.00 ± 1.14); Of the 328 patients who underwent conventional laparoscopic surgery, the mean age of them were (68.42 ± 6.85) years old, the youngest 44 years old, the oldest 89 years old and the Gleason score (7.45 ± 1.25);
2. The cost measurement results show that the average cost of RALRP is (30551.25-35504.09) yuan, higher than LRP (10000.00-20000.00) yuan; the cost component analysis results show that equipment purchases, consumables, and maintenance account for a high proportion, indicating that the variable cost of equipment maintenance and consumables is related to the amount of RALRP surgery; The average cost of RALRP surgery for ＂Zhejiang University First＂ is lower than that of ＂Provincial People＂ (29325.82＜ 33,191.17 yuan), indicating that the average cost of surgery is different from which divided into the cost of each surgery；
3. The results of the clinical effect analysis indicated that compared with the LRP group, the average operative time of the RALRP group was shortened by 1.00 hour, the average intraoperative blood loss was reduced by 110 ml, the hospitalization time was shortened by an average of 3.40 days, and the postoperative catheter indwelling time was shortened by an average of 1.27 days.
4. The simulation results show that when the cost of surgery in the RALRP group is 35,504.09 yuan, the surgical outcomes that are similar to the oncological outcomes of the LRP group are not sufficient to compensate for the high cost of surgery; in the incremental cost effect analysis, compared with the LRP group, RALRP For each group of hemorrhage with 1 ml reduction, it will cost 219.89 yuan more, reducing hospitalized days for 1 day will cost 7025.12 yuan, reducing the operating time for 1 hour will cost 11104.23 yuan more; Single-factor sensitivity analysis suggests that consumables have a greater impact on costs.
Conclusion:
RALRP surgery is safe, but it’s average cost is higher than LRP, so it is important to induce the cost when the hospital applies and promotes it; And the average cost of RALRP for ＂Zhejiang University First＂ is lower than that of the ＂Provincial People＂, revealing that the increase in the amount of surgery can, to some extent, reduce the average cost of the procedure. Therefore, it is recommended that hospitals subdivide patient groups and take targeted treatment measures based on the patient＇s economic conditions and their wishes when promoting this technology.
Translated Keyword
[activity-based costing, Decision tree, Health economic evaluation, LRP, Radical prostatectomy, RALRP]
Corresponding authors email
