Abstract：
BACKGROUND: Although several studies report that the robotic approach is more costly than laparoscopy, the cost-effectiveness of robotic distal pancreatectomy (RDP) over laparoscopic distal pancreatectomy (LDP) is still an issue. This study evaluates the cost-effectiveness of the RDP and LDP approaches across several Spanish centres.
METHODS: This study is an observational, multicenter, national prospective study (ROBOCOSTES). For one year from 2022, all consecutive patients undergoing minimally invasive distal pancreatectomy were included, and clinical, QALY, and cost data were prospectively collected. The primary aim was to analyze the cost-effectiveness between RDP and LDP.
RESULTS: During the study period, 80 procedures from 14 Spanish centres were analyzed. LDP had a shorter operative time than the RDP approach (192.2 min vs 241.3 min, p = 0.004). RDP showed a lower conversion rate (19.5% vs 2.5%, p = 0.006) and a lower splenectomy rate (60% vs 26.5%, p = 0.004). A statistically significant difference was reported for the Comprehensive Complication Index between the two study groups, favouring the robotic approach (12.7 vs 6.1, p = 0.022). RDP was associated with increased operative costs of 1600 euros (p < 0.031), while overall cost expenses resulted in being 1070.92 Euros higher than the LDP but without a statistically significant difference (p = 0.064). The mean QALYs at 90 days after surgery for RDP (0.9534) were higher than those of LDP (0.8882) (p = 0.030). At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was a 62.64% and 71.30% probability that RDP was more cost-effective than LDP, respectively.
CONCLUSIONS: The RDP procedure in the Spanish healthcare system appears more cost-effective than the LDP.
METHODS: This study is an observational, multicenter, national prospective study (ROBOCOSTES). For one year from 2022, all consecutive patients undergoing minimally invasive distal pancreatectomy were included, and clinical, QALY, and cost data were prospectively collected. The primary aim was to analyze the cost-effectiveness between RDP and LDP.
RESULTS: During the study period, 80 procedures from 14 Spanish centres were analyzed. LDP had a shorter operative time than the RDP approach (192.2 min vs 241.3 min, p = 0.004). RDP showed a lower conversion rate (19.5% vs 2.5%, p = 0.006) and a lower splenectomy rate (60% vs 26.5%, p = 0.004). A statistically significant difference was reported for the Comprehensive Complication Index between the two study groups, favouring the robotic approach (12.7 vs 6.1, p = 0.022). RDP was associated with increased operative costs of 1600 euros (p < 0.031), while overall cost expenses resulted in being 1070.92 Euros higher than the LDP but without a statistically significant difference (p = 0.064). The mean QALYs at 90 days after surgery for RDP (0.9534) were higher than those of LDP (0.8882) (p = 0.030). At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was a 62.64% and 71.30% probability that RDP was more cost-effective than LDP, respectively.
CONCLUSIONS: The RDP procedure in the Spanish healthcare system appears more cost-effective than the LDP.
摘要：
背景：尽管一些研究报告说机器人方法比腹腔镜检查更昂贵，机器人远端胰腺切除术(RDP)相对于腹腔镜远端胰腺切除术(LDP)的成本效益仍然是一个问题.这项研究评估了西班牙几个中心的RDP和LDP方法的成本效益。
方法：这项研究是一项观察性的，多中心，国家前瞻性研究(ROBOCOSTES)。从2022年开始的一年中，所有连续接受微创远端胰腺切除术的患者都包括在内，临床,QALY,和成本数据是前瞻性收集的。主要目的是分析RDP和LDP之间的成本效益。
结果：在研究期间，分析了来自14个西班牙中心的80例手术。LDP的手术时间比RDP方法短（192.2分钟vs241.3分钟，p=0.004)。RDP的转化率较低（19.5%vs2.5%，p=0.006）和较低的脾切除术率（60％vs26.5％，p=0.004)。据报道，两个研究组之间的综合并发症指数差异具有统计学意义。支持机器人方法(12.7vs6.1，p=0.022)。RDP与1600欧元的手术成本增加相关(p<0.031)，而总体费用支出导致比LDP高1070.92欧元，但没有统计学上的显着差异（p=0.064）。RDP手术后90天的平均QALY（0.9534）高于LDP（0.8882）（p=0.030）。在2万和3万欧元的支付意愿门槛下，RDP比LDP更具成本效益的可能性分别为62.64%和71.30%，分别。
结论：西班牙医疗保健系统中的RDP程序似乎比LDP更具成本效益。
方法：这项研究是一项观察性的，多中心，国家前瞻性研究(ROBOCOSTES)。从2022年开始的一年中，所有连续接受微创远端胰腺切除术的患者都包括在内，临床,QALY,和成本数据是前瞻性收集的。主要目的是分析RDP和LDP之间的成本效益。
结果：在研究期间，分析了来自14个西班牙中心的80例手术。LDP的手术时间比RDP方法短（192.2分钟vs241.3分钟，p=0.004)。RDP的转化率较低（19.5%vs2.5%，p=0.006）和较低的脾切除术率（60％vs26.5％，p=0.004)。据报道，两个研究组之间的综合并发症指数差异具有统计学意义。支持机器人方法(12.7vs6.1，p=0.022)。RDP与1600欧元的手术成本增加相关(p<0.031)，而总体费用支出导致比LDP高1070.92欧元，但没有统计学上的显着差异（p=0.064）。RDP手术后90天的平均QALY（0.9534）高于LDP（0.8882）（p=0.030）。在2万和3万欧元的支付意愿门槛下，RDP比LDP更具成本效益的可能性分别为62.64%和71.30%，分别。
结论：西班牙医疗保健系统中的RDP程序似乎比LDP更具成本效益。
