723 860
Bijlani (2016)
[29]
NA
Cost modeling Review of the
published literature to
estimate outcomes
RARP
versus RRP
Costs modeled based
on care pathways and
published government
and other sources
Reimbursements for
procedure,
complications,
functional outcomes
and adjuvant
treatment within 3 yr
Direct and indirect
costs
Hospital
Payer
Societal
RARP cost $341 (2014) more than RRP.
RARP saved $1451 (2014), mainly because of
lower complication, incontinence, and sexual
dysfunction costs.
RARP saved $1202 due to faster recovery and
less lost wages.
Risk of bias and potential for COI is high as this
study was conducted by Intuitive Surgical
employees.
Note: In the payer perspective analyses, no
sensitivity analyses are presented, which
would have been helpful as estimates around
incontinence and sexual dysfunction vary a lot
in the literature.
Studies from the societal perspective
O’Malley (2007)
[37]NA
Cost-utility
evaluation
Local accounting data,
estimation of QALY
from the literature
RARP
versus RRP
Actual costs from local
hospital (including
direct and indirect
cost) 2005
Directly obtained
direct and indirect
costs from local
hospital accounting
Society
Cost per QALY A$24 457 (clearly below the
generally accepted range)
Risk of bias is deemed high: gain in QALY by
robotic prostatectomy was quite optimistic,
using only data from one study
[85] . No
sensitivity analyses were performed.
Hohwu¨ (2011)
[38]
77 RARP
154 RRP
Retrospective
cohort study
Institutional data and
data from the
literature
RARP
versus RRP
Economic evaluation
calculating
incremental cost-
effectiveness ratio per
successful surgery and
per QALY
Includes direct and
indirect costs
Societal
perspective
RARP mean cost:
s
21 780 (2008)
RRP mean cost:
s
16 328 (2008)
Difference:
s
5452 (2008)
ICER for successful surgery (cancer control, no
incontinence, erectile function):
s
77 857
No QALY benefit for RARP over RRP based on
SF-36.
Study limited by a low number of patients
included and by significant amount of
uncertainty surrounding the proportion of
patients treated with ‘‘successful surgery’’.
Epstein (2013)
[32]
10 032 MIRP
13 778 RRP
Retrospective
cohort study
Truven MarketScan
database 2000–2009
(employer sponsored
health plans)
MIRP
versus RRP
1. Health plan
expenditures on
medical care,
including both
medical and pharmacy
costs
2. Days absent from
work
Expenditures were
measured
(presumably
representing both
direct and indirect
costs)
Payer
Societal
MIRP spending significantly higher than that
for RRP in adjusted analyses ($1350 in the 1st
year after surgery, 2009).
Days absent from work significantly shorter
after MIRP than RRP in adjusted analyses (9 d).
Risk of bias is moderate, as unobserved
confounding may have affected results.
E U R O P E A N U R O L O G Y 7 2 ( 2 0 1 7 ) 7 1 2 – 7 3 5
723