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Cost-effectiveness and quality of life analysis of laparoscopic and robotic distal pancreatectomy: a propensity score-matched study

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Abstract

Background

This study analyzed the Quality of Life (QoL) and cost-effectiveness of laparoscopic (LDP) versus robotic distal pancreatectomy (RDP).

Method

All patients who underwent LDP or RDP from 2011 to 2017 and with a minimum postoperative follow-up of 12 months were included in the study. To minimize bias, a propensity score-matched analysis (1:2) was performed. Two different questionnaires (EORTC QLQ-C30 and EQ-5D) were completed by the patients. The mean differential cost and mean differential Quality Adjusted Life Years (QALY) were calculated and plotted on a cost-utility plane.

Results

The study population consisted of 152 patients. After having applied the propensity score matching, the final population included 103 patients divided into RDP group (n = 37, 36%) and LDP (n = 66, 64%). No differences were found between groups regarding the baseline, intraoperative, postoperative, and pathological variables (p > 0.05). The QoL analysis showed a significant improvement in the RDP group on the postoperative social function, nausea, vomiting, and financial status (p = 0.010, p = 0.050, and p = 0.030, respectively). As expected, the crude costs analysis confirmed that RDP was more expensive than LDP (12,053 Euros vs. 5519 Euros, p < 0.001). However, the robotic approach had a higher probability of being more cost-effective than the laparoscopic procedure when a willingness to pay of more than 4800 Euros/QALY was accepted.

Conclusion

RDP was associated with QoL improvement in specific domains. Crude costs were higher relative to LDP. Cost-effectiveness threshold resulted to be 4800 euros/QALY. The increasing worldwide diffusion of the robotic technology, with easier access and possible cost reduction, could increase the sustainability of this procedure.

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Acknowledgements

the present study was performed on the behalf of the EAES in the research program of the EAES Research Talent Academy. We would also like to show our gratitude to Dr Ferdinando Agresta, tutor during the project, for his comments and assistance.

Funding

No funding has been received.

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Authors and Affiliations

  1. General and Pancreatic Surgery Department, Pancreas Institute, University and Hospital Trust of Verona, Policlinico GB Rossi, Piazzale L.A. Scuro, 10, 37134, Verona, Italy

    Matteo De Pastena, Alessandro Esposito, Salvatore Paiella, Niccolò Surci, Greta Montagnini, Giovanni Marchegiani, Giuseppe Malleo, Erica Secchettin, Luca Casetti, Luca Landoni, Claudio Bassi & Roberto Salvia

  2. Department of Medical and Surgical Sciences—DIMEC, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Claudio Ricci

  3. Healthcare Department Administrator, Azienda Ospedaliera Universitaria Integrata (AOUI), Verona, Italy

    Chiara Bovo

Authors
  1. Matteo De Pastena
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  2. Alessandro Esposito
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  3. Salvatore Paiella
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  4. Niccolò Surci
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  6. Giovanni Marchegiani
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  7. Giuseppe Malleo
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  8. Erica Secchettin
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  9. Luca Casetti
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  10. Claudio Ricci
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  11. Luca Landoni
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  13. Claudio Bassi
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  14. Roberto Salvia
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Corresponding author

Correspondence to Matteo De Pastena.

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Disclosures

Matteo De Pastena, Alessandro Esposito, Salvatore Paiella MD, Niccolò Surci, Greta Montagnini, Giovanni Marchegiani, Giuseppe Malleo, Erica Secchettin, Luca Casetti, Claudio Ricci, Luca Landoni, Chiara Bovo, Claudio Bassi, Roberto Salvia have no conflicts of interest or financial ties to disclose.

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De Pastena, M., Esposito, A., Paiella, S. et al. Cost-effectiveness and quality of life analysis of laparoscopic and robotic distal pancreatectomy: a propensity score-matched study. Surg Endosc 35, 1420–1428 (2021). https://doi.org/10.1007/s00464-020-07528-1

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  • DOI: https://doi.org/10.1007/s00464-020-07528-1

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