A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy

Figures & data

Table 1.  Assessment of cost components in the economic evaluation.

	Euro	Ref.
Fixed costs per da Vinci procedure yearly*	3,456
Equipment costs per operation:
RALP	1,884	[14]
RRP	316	[14]
Average hourly rate:
Surgeon	63	[15]
Specialist registrar, urology	43	[15]
Anaesthesiologist	61	[15]
RN at operation and recovery ward	28	[15]
RN at anaesthesiology ward	29	[15]
‘Hotel’ – costs per day†	281	[16]
Blood transfusion each	135	[17]
Outpatient visit per visit (mean)	267	[18]
Re-admission at hospital per day (mean)	892	[18]
Consultation at GP‡	33	[19]
Pad each	0.5	[20,21]
Absence from work per day	186	[22]
Home visit by community nurse, per hour	67	[23]
Medical treatment, erectile dysfunction:
Injection Caverject, each§	20	[24]
Injection Invicorp, each	20	[24]
Tablet viagra, each	12	[24]
Tablet cialis, each	13	[24]
Tablet Levitra, each¶	11	[24]
Treatment, recurrence:
Tablet Casodex 150 mg apiece	16	[24]
Profylax mammae radiation therapy	380	[16]
Radiation therapy, 39 fractions	29,678	[16]

*Based on 110 operations yearly; †Stay at the ward: all costs and gross salary including pay supplement; ‡Fee for a consultation of 10 min; §Average price of 10 and 20 µg; ¶Average price of 5, 10 and 20 µg.

RALP, robot-assisted laparoscopic radical prostatectomy; RRP, retropubic radical prostatectomy; RN, registered nurse; GP, general practitioner.

Table 2.  Effects used in the economic evaluation based on matched* groups of patients and estimated at 1 year postoperatively.

	RALP	RRP	Difference†	p-value
Effects
Number of patients	77	154
PSA <0.2 ng/ml‡; n (%)	73 (94.8)	133 (86.4)		0.05§
Urinary continence (0–1 pad per day)‡; n (%)	67 (87)	108 (70)
Erectile function with or without medication‡; n (%)	31 (40.3)	68 (44.2)
Prescriptions used for erectile dysfunction¶; n (%)	27 (35.1)	38 (24.7)
Successful treatment**, n (%)
Number of patients	77	154
Yes	26 (34)	42 (27)	7%	0.30††
No	51 (66)	112 (73)
QALY
Number of patients (%)	26 (33.8)	115 (74.7)
Gain of QALY‡‡ [95% CI]	0.0103 [−0.2895 to 0.3100]	0.0116 [−0.3272 to 0.3727]	−0.0065

*Matched on preoperative age, PSA, T-stage and Gleason score; †Difference: effect (RALP) – effect (RRP); ‡1 year postoperatively; §χ²-test; ¶Registered from a public database of health service at Central Denmark Region; **No residual cancer (PSA <0.2 ng/ml), urinary continence and erectile function with or without medication; ††Unpaired t-test; ‡‡Mean gain.

QALY, quality-adjusted life-years; PSA, prostate-specific antigen; RALP, robot-assisted laparoscopic radical prostatectomy; RRP, retropubic radical prostatectomy.

Table 3.  Mean costs, effects, and incremental cost-effectiveness ratio per successful operation 1 year postoperatively. The parameters are calculated as direct costs and indirect costs (direct costs including absences from work), respectively.

	RALP (n = 77)			RRP (n = 154)			ICER (€)
	Mean (€)	95% CI	Effect* (%)	Mean (€)	95% CI	Effect* (%)	per successful operation*
Direct costs	8,369	[7,742–9,320]	34	3,863	[3,437–4,478]	27	64,343
Indirect costs	13,411	[11,320–17,264]	34	12,465	[9,611–15,318]	27	13,514

*Patients with the outcome measure 'Successful operation' (No residual cancer (PSA <0.2 ng/ml), urinary continence and erectile function with or without medication).

€, euro; RALP, robot-assisted laparoscopic prostatectomy; RRP, retropubic radical prostatectomy; CI, confidence interval, non-parametric bootstrap; PSA, prostate-specific antigen.

Figure 1.  Impact of one-way sensitivity analysis with selected parameters on the estimated ICER of €64,343 per successful treatment using robot-assisted laparoscopic radical prostatectomy. The ICER was estimated assuming 70 RALP were performed annually with the costs for the da Vinci distributed between 110 robot-assisted procedures yearly and a life time for the da Vinci robot of 5 years. A successful treatment was defined as no residual cancer (prostate-specific antigen <0.2 ng/ml), preserved urinary continence and erectile function 1 year postoperatively. RALP robot-assisted laparoscopic radical prostatectomy; RRP, retropubic radical prostatectomy; PSA prostate-specific antigen; PO, postoperatively; ICER, incremental cost-effectiveness ratio.