背景:机器人技术已安全且成功地用于各种成人手术,并且在儿科中逐渐普及。虽然机器人辅助手术在疾病治疗中的好处是公认的,它的高成本引起了人们的质疑。探讨在儿科手术中,机器人辅助腹腔镜手术(RALS)与传统腹腔镜手术(LS)相比是否具有成本效益,我们尝试构建一个模型,使用Python统计分析软件对这两种手术入路进行分析.
方法:我们选择了四种常见的复杂儿科手术条件(胆总管囊肿,赫氏弹簧病,膀胱输尿管反流,和先天性肾积水)来自三个系统(小儿肝胆,胃肠病学,和泌尿科)。使用Python统计软件构建模型,以比较RALS和LS的住院费用和手术结果。此外,我们对两种手术方式进行了首选策略分析,同时使用单向敏感性分析评估模型不确定性.
结果:对于这四种疾病,手术时间依次减少。RALS的住院总费用为10,816.72、9145.44、8414.29、7973.58美元,分别,术后两年内产生1.789、1.712、1.749、1.792质量调整寿命年(QALYs)。每种疾病的RALS相对于LS的增量成本为3523.44、3200.20、3049.79、3043.66美元,分别,增量效用为0.060、0.054、0.051、0.050QALYs。四种疾病中每种疾病的RALS的增量成本效益比(ICER)分别为58,724.01、59,262.95、59,799.79、60,873.20美元/QALY,都低于100,000美元/QALY。机器人耗材成本是RALS的主要增量成本,对模型的影响最为显著。
结论:对于上述四种儿科手术条件,RALS的住院费用比LS高,但它有更好的术后结果,所有四种RALS治疗都具有成本效益。患有复杂疾病和手术时间长的儿童似乎从RALS中受益更多。
Robotics has been used safely and successfully in a variety of adult surgeries and is gradually gaining ground in pediatrics. While the benefits of robotic-assisted surgery in disease treatment are well recognized, its high cost has led to questions. To investigate whether robotic-assisted laparoscopic surgery (RALS) is cost-effective compared to conventional laparoscopic surgery (LS) in pediatric surgery, we attempted to construct a model to perform an analysis of these two surgical approaches using Python statistical analysis software.
We selected four common complex pediatric surgical conditions (choledochal cyst, Hirschsprung\'s disease, vesicoureteral reflux, and congenital hydronephrosis) from three systems (pediatric hepatobiliary, gastroenterology, and urology). Models were constructed using Python statistical software to compare hospital costs and surgical outcomes for RALS and LS. In addition, we performed a preferred strategy analysis for both surgical modalities while assessing model uncertainty using one-way sensitivity analysis.
For the four diseases, the operative time decreased sequentially. The total inpatient costs of RALS were 10,816.72, 9145.44, 8414.29, 7973.58 dollars, respectively, yielding 1.789, 1.712, 1.749, 1.792 quality adjustment life years (QALYs) over two years post-operatively. The incremental cost of RALS relative to LS for each disease was 3523.44, 3200.20, 3049.79, 3043.66 dollars, respectively, with an incremental utility of 0.060, 0.054, 0.051, 0.050 QALYs. The incremental cost-effectiveness ratios (ICERs) for RALS for each of the four diseases were 58,724.01, 59,262.95, 59,799.79, 60,873.20 dollars/QALY, all less than 100,000 dollars/QALY. The cost of robot consumables was the main incremental cost of RALS and had the most significant impact on the model.
For the four pediatric surgical conditions described above, RALS has higher inpatient costs than LS, but it has better postoperative outcomes, and all four RALS treatments are cost-effective. Children with complex diseases and long operative times appear to benefit more from RALS.