Abstract：
BACKGROUND: This study compared the cost-effectiveness of open (ODP), laparoscopic (LDP), and robotic (RDP) distal pancreatectomy (DP).
METHODS: Studies reporting the costs of DP were included in a literature search until August 2023. Bayesian network meta-analysis was conducted, and surface under cumulative ranking area (SUCRA) values, mean difference (MD), odds ratio (OR), and 95% credible intervals (CrIs) were calculated for outcomes of interest. Cluster analysis was performed to examine the similarity and classification of DP approaches into homogeneous clusters. A decision model-based cost-utility analysis was conducted for the cost-effectiveness analysis of DP strategies.
RESULTS: Twenty-six studies with 29,164 patients were included in the analysis. Among the three groups, LDP had the lowest overall costs, while ODP had the highest overall costs (LDP vs. ODP: MD - 3521.36, 95% CrI - 6172.91 to - 1228.59). RDP had the highest procedural costs (ODP vs. RDP: MD - 4311.15, 95% CrI - 6005.40 to - 2599.16; LDP vs. RDP: MD - 3772.25, 95% CrI - 4989.50 to - 2535.16), but incurred the lowest hospitalization costs. Both LDP (MD - 3663.82, 95% CrI - 6906.52 to - 747.69) and RDP (MD - 6678.42, 95% CrI - 11,434.30 to - 2972.89) had significantly reduced hospitalization costs compared to ODP. LDP and RDP demonstrated a superior profile regarding costs-morbidity, costs-mortality, costs-efficacy, and costs-utility compared to ODP. Compared to ODP, LDP and RDP cost $3110 and $817 less per patient, resulting in 0.03 and 0.05 additional quality-adjusted life years (QALYs), respectively, with positive incremental net monetary benefit (NMB). RDP costs $2293 more than LDP with a negative incremental NMB but generates 0.02 additional QALYs with improved postoperative morbidity and spleen preservation. Probabilistic sensitivity analysis suggests that LDP and RDP are more cost-effective options compared to ODP at various willingness-to-pay thresholds.
CONCLUSIONS: LDP and RDP are more cost-effective than ODP, with LDP exhibiting better cost savings and RDP demonstrating superior surgical outcomes and improved QALYs.
METHODS: Studies reporting the costs of DP were included in a literature search until August 2023. Bayesian network meta-analysis was conducted, and surface under cumulative ranking area (SUCRA) values, mean difference (MD), odds ratio (OR), and 95% credible intervals (CrIs) were calculated for outcomes of interest. Cluster analysis was performed to examine the similarity and classification of DP approaches into homogeneous clusters. A decision model-based cost-utility analysis was conducted for the cost-effectiveness analysis of DP strategies.
RESULTS: Twenty-six studies with 29,164 patients were included in the analysis. Among the three groups, LDP had the lowest overall costs, while ODP had the highest overall costs (LDP vs. ODP: MD - 3521.36, 95% CrI - 6172.91 to - 1228.59). RDP had the highest procedural costs (ODP vs. RDP: MD - 4311.15, 95% CrI - 6005.40 to - 2599.16; LDP vs. RDP: MD - 3772.25, 95% CrI - 4989.50 to - 2535.16), but incurred the lowest hospitalization costs. Both LDP (MD - 3663.82, 95% CrI - 6906.52 to - 747.69) and RDP (MD - 6678.42, 95% CrI - 11,434.30 to - 2972.89) had significantly reduced hospitalization costs compared to ODP. LDP and RDP demonstrated a superior profile regarding costs-morbidity, costs-mortality, costs-efficacy, and costs-utility compared to ODP. Compared to ODP, LDP and RDP cost $3110 and $817 less per patient, resulting in 0.03 and 0.05 additional quality-adjusted life years (QALYs), respectively, with positive incremental net monetary benefit (NMB). RDP costs $2293 more than LDP with a negative incremental NMB but generates 0.02 additional QALYs with improved postoperative morbidity and spleen preservation. Probabilistic sensitivity analysis suggests that LDP and RDP are more cost-effective options compared to ODP at various willingness-to-pay thresholds.
CONCLUSIONS: LDP and RDP are more cost-effective than ODP, with LDP exhibiting better cost savings and RDP demonstrating superior surgical outcomes and improved QALYs.
摘要：
背景：这项研究比较了开放式（ODP）的成本效益，腹腔镜（LDP），和机器人（RDP）远端胰腺切除术（DP）。
方法：报告DP成本的研究被纳入文献检索，直至2023年8月。进行了贝叶斯网络荟萃分析，和表面下累积排序面积(SUCRA)值，平均差(MD)，比值比(OR)，并为感兴趣的结果计算95%的可信区间(CrIs)。进行了聚类分析，以检查DP方法的相似性和分类为同质簇。采用基于决策模型的成本效用分析方法对DP策略进行成本效益分析。
结果：分析中纳入了29,164名患者的26项研究。在三组中，自民党的总成本最低,而ODP的总体成本最高(LDP与ODP：MD-3521.36，95%CrI-6172.91至-1228.59）。RDP的程序成本最高(ODP与RDP：MD-4311.15，95%CrI-6005.40至-2599.16；LDP与RDP：MD-3772.25，95%CrI-4989.50至-2535.16），但住院费用最低。与ODP相比，LDP（MD-3663.82，95％CrI-6906.52至-747.69）和RDP（MD-6678.42，95％CrI-11,434.30至-2972.89）均显着降低了住院费用。LDP和RDP在成本-发病率方面表现出优异的表现，成本-死亡率，成本效益，与ODP相比，成本-效用。与ODP相比，LDP和RDP每位患者的费用为3110美元，费用为817美元。导致0.03和0.05个额外的质量调整寿命年(QALYs)，分别,净货币收益(NMB)为正增量。RDP的成本比LDP高2293美元，NMB为负增量，但可产生0.02个额外的QALY，术后发病率和脾脏保存得到改善。概率敏感性分析表明，在各种支付意愿阈值下，与ODP相比，LDP和RDP是更具成本效益的选择。
结论：LDP和RDP比ODP更具成本效益，LDP表现出更好的成本节约，RDP表现出优异的手术效果和改善的QALYs。
方法：报告DP成本的研究被纳入文献检索，直至2023年8月。进行了贝叶斯网络荟萃分析，和表面下累积排序面积(SUCRA)值，平均差(MD)，比值比(OR)，并为感兴趣的结果计算95%的可信区间(CrIs)。进行了聚类分析，以检查DP方法的相似性和分类为同质簇。采用基于决策模型的成本效用分析方法对DP策略进行成本效益分析。
结果：分析中纳入了29,164名患者的26项研究。在三组中，自民党的总成本最低,而ODP的总体成本最高(LDP与ODP：MD-3521.36，95%CrI-6172.91至-1228.59）。RDP的程序成本最高(ODP与RDP：MD-4311.15，95%CrI-6005.40至-2599.16；LDP与RDP：MD-3772.25，95%CrI-4989.50至-2535.16），但住院费用最低。与ODP相比，LDP（MD-3663.82，95％CrI-6906.52至-747.69）和RDP（MD-6678.42，95％CrI-11,434.30至-2972.89）均显着降低了住院费用。LDP和RDP在成本-发病率方面表现出优异的表现，成本-死亡率，成本效益，与ODP相比，成本-效用。与ODP相比，LDP和RDP每位患者的费用为3110美元，费用为817美元。导致0.03和0.05个额外的质量调整寿命年(QALYs)，分别,净货币收益(NMB)为正增量。RDP的成本比LDP高2293美元，NMB为负增量，但可产生0.02个额外的QALY，术后发病率和脾脏保存得到改善。概率敏感性分析表明，在各种支付意愿阈值下，与ODP相比，LDP和RDP是更具成本效益的选择。
结论：LDP和RDP比ODP更具成本效益，LDP表现出更好的成本节约，RDP表现出优异的手术效果和改善的QALYs。
