Is robotic right colectomy economically sustainable? a multicentre retrospective comparative study and cost analysis
Is robotic right colectomy economically sustainable? a multicentre retrospective comparative study and cost analysis
复制标题
机器人右结肠切除术在经济上是可持续的吗？一项多中心回顾性对照研究和成本分析
DOI：
10.1007/s00464-019-07193-z
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发表时间：
2019-10-15
影响因子：
3.1
通讯作者：
Bracale, Umberto
中科院分区：
文献类型：
--
作者：
Merola, Giovanni;Sciuto, Antonio;Bracale, Umberto
背景随着美国食品和药物管理局的批准，机器人辅助结直肠手术得到了更多外科医生的接受。机器人手术的一个悬而未决的问题是经济可持续性。我们研究的目的是评估与意大利国家卫生系统的腹腔镜右结肠切除术相比，机器人手术的经济可持续性。方法我们进行了一项多中心病例配对研究，每组94名患者，分别来自意大利四个不同的外科科室。一项从真实世界数据中收集的经济评估被用来评估机器人方法在意大利国家卫生系统中进行右半结肠切除术的可持续性。特别是，进行了两种程序之间的差异成本分析。结果两组患者术后疗效差异无统计学意义。根据我们的数据，仔细查阅了关于手术室、医疗器械和住院费用评估的文献后，我们估计如下：(A)机器人组的平均手术室成本为2179+/-476欧元，腹腔镜组为1376+/-322欧元；(B)机器人组的平均住院费用为3143+/-1435欧元，腹腔镜组为3292+/-1123欧元；(C)机器组的平均器械费用为6280欧元，腹腔镜组为1504欧元。机器人右结肠切除术的总平均成本为11576+/-1915欧元，而腹腔镜右结肠切除术的总平均成本为6196+/-1444欧元。结论：到目前为止，机器人右半结肠切除联合腔内吻合术没有提供任何显著的临床优势，这可能证明了与腹腔镜手术相比，额外的费用是合理的。机器人技术和经验的进一步发展可能会导致成本的降低，特别是如果机器人平台用于适当的医疗保健环境中。
Background Following the Food and Drug Administration approval, robot-assisted colorectal surgery has gained more acceptance among surgeons. One of the open issues about robotic surgery is the economic sustainability. The aim of our study is to evaluate the economic sustainability of robotic as compared to laparoscopic right colectomy for the Italian National Health System. Methods We performed a retrospective multicentre case-matched study including 94 patients for each group from four different Italian surgical departments. An economic evaluation gathered from a real-world data was performed to assess the sustainability of the robotic approach for right colectomy in the Italian National Health System. In particular, a differential cost analysis between the two procedures was performed. Results No statistical differences were found between the two groups for postoperative outcomes. After a careful review of the literature on the cost assessment for the operative room, medical devices and hospital stay according with our data, we estimated the followings: (a) the mean operative room cost for robotic group was 2179 +/- 476 euro vs. 1376 +/- 322 euro for laparoscopic group; (b) the mean hospital stay cost for robotic group was 3143 +/- 1435 euro vs. 3292 +/- 1123 euro for laparoscopic group; and (c) the mean cost for instruments was 6280 euro for robotic group vs. 1504 euro for laparoscopic group. The total mean cost of robotic right colectomy was 11,576 +/- 1915 euro vs. 6196 +/- 1444 euro for laparoscopic right colectomy. Conclusion In conclusion, to date, robotic right colectomy with intracorporeal anastomosis does not provide any significant clinical advantages, which may justify the additional costs, as compared to its laparoscopic counterpart. Further evolution of robotic technology and experience may lead to a reduction of costs, especially if the robotic platform is used in an appropriate healthcare setting.