Health Economic Analysis of Open and Robot-assisted Laparoscopic Surgery for Prostate Cancer Within the Prospective Multicentre LAPPRO Trial

The rapid adoption of robot-assisted laparoscopy in radical prostatectomy has preceded data regarding associated costs. Qualitative evidence regarding cost outcomes is lacking.

This study assessed how costs were affected by robot-assisted laparoscopic prostatectomy (RALP) compared with open surgery.

Cost analysis was based on the dataset of the LAPPRO (Laparoscopic Prostatectomy Robot Open) clinical trial, which is a prospective controlled, nonrandomised trial of patients who underwent prostatectomy at 14 centres in Sweden between September 2008 and November 2011. Currently, data are available from a follow-up period of 24 mo.

In the LAPPRO trial, RALP was compared with radical retropubic prostatectomy (RRP).

Costs per surgical technique were assessed based on resource variable data from the LAPPRO database. The calculation of average costs was based on mean values; Swedish currency was converted to purchasing power parity US dollar (PPP$). All tests were two-tailed and conducted at α=0.05 significance level.

The cost analysis comprised 2638 men. Based on the LAPPRO trial data, RALP was associated with an increased cost/procedure of PPP$ 3837 (95% confidence interval: 2747-4928) compared with RRP. The result was sensitive to variations in caseload. Main drivers of overall cost were robotic system cost, operation time, length of stay, and sick leave. Limitations of the study include the uneven distribution between RALP and RRP regarding procedures in public/for-profit hospitals and surgeon/centre procedural volume.

Based on the LAPPRO trial data, this study showed that RALP was associated with an increased cost compared with RRP in Swedish health care. There are many factors influencing the costs, making the absolute result dependent on the specific setting. However, by identifying the main cost drivers and/or most influential parameters, the study provides support for informed decisions and predictions.

In this study, we looked at the cost outcome when performing prostatectomies by robot-assisted laparoscopic technique compared with open surgery in Sweden. We found that the robot-assisted procedure was associated with a higher mean cost.

European urology. 2018 Aug 21 [Epub ahead of print]

Annabelle Forsmark, Jacob Gehrman, Eva Angenete, Anders Bjartell, Ingela Björholt, Stefan Carlsson, Jonas Hugosson, Tom Marlow, Karin Stinesen-Kollberg, Johan Stranne, Anna Wallerstedt, Peter Wiklund, Ulrica Wilderäng, Eva Haglind

Nordic Health Economics, Gothenburg, Sweden. Electronic address: ., Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden., Department of Urology, Skåne University Hospital, Lund University, Lund, Sweden., Nordic Health Economics, Gothenburg, Sweden., Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden., Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden., Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.