Robotic and laparoscopic gynaecological surgery: a prospective multicentre observational cohort study and economic evaluation in England

Andrew McCarthy; Dilupa Samarakoon; Joanne Gray; Peter Mcmeekin; Stephen McCarthy; Claire Newton; Marielle Nobbenhuis; Jonathan Lippiatt; Jeremy Twigg

doi:10.1136/bmjopen-2023-073990

Robotic and laparoscopic gynaecological surgery: a prospective multicentre observational cohort study and economic evaluation in England

BMJ Open. 2023 Sep 28;13(9):e073990. doi: 10.1136/bmjopen-2023-073990.

Authors

Andrew McCarthy¹, Dilupa Samarakoon², Joanne Gray², Peter Mcmeekin², Stephen McCarthy², Claire Newton^{3

4}, Marielle Nobbenhuis⁵, Jonathan Lippiatt⁶, Jeremy Twigg⁷

Affiliations

¹ Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK andrew2.mccarthy@northumbria.ac.uk.
² Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK.
³ Department of Gynaecology Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
⁴ University of Bristol, Bristol, UK.
⁵ Department of Gynaecological Oncology, Royal Marsden NHS Foundation Trust, London, UK.
⁶ Department of Gynaecological Oncology, University Hospitals Dorset NHS Foundation Trust, Poole, UK.
⁷ Department of Gynaecological Oncology, Coventry and Warwickshire Hospital, Coventry, UK.

Abstract

Objective: To compare the health-related quality of life and cost-effectiveness of robot-assisted laparoscopic surgery (RALS) versus conventional 'straight stick' laparoscopic surgery (CLS) in women undergoing hysterectomy as part of their treatment for either suspected or proven gynaecological malignancy.

Design: Multicentre prospective observational cohort study.

Setting: Patients aged 16+ undergoing hysterectomy as part of their treatment for gynaecological malignancy at 12 National Health Service (NHS) cancer units and centres in England between August 2017 and February 2020.

Participants: 275 patients recruited with 159 RALS, 73 CLS eligible for analysis.

Outcome measures: Primary outcome was the European Organisation for Research and Treatment of Cancer Quality of Life measure (EORTC). Secondary outcomes included EuroQol-5 Dimension (EQ-5D-5L) utility, 6-minute walk test (6MWT), NHS costs using pounds sterling (£) 2018-2019 prices and cost-effectiveness. The cost-effectiveness evaluation compared EQ-5D-5L quality adjusted life years and costs between RALS and CLS.

Results: No difference identified between RALS and CLS for EORTC, EQ-5D-5L utility and 6MWT. RALS had unadjusted mean cost difference of £556 (95% CI -£314 to £1315) versus CLS and mean quality adjusted life year (QALY) difference of 0.0024 (95% CI -0.00051 to 0.0057), non-parametric incremental cost-effectiveness ratio of £231 667per QALY. For the adjusted cost-effectiveness analysis, RALS dominated CLS with a mean cost difference of -£188 (95% CI -£1321 to £827) and QALY difference of 0.0024 (95% CI -0.0008 to 0.0057).

Conclusions: Findings suggest that RALS versus CLS in women undergoing hysterectomy (after adjusting for differences in morbidity) is cost-effective with lower costs and QALYs. Results are highly sensitive to the usage of robotic hardware with higher usage increasing the probability of cost-effectiveness. Non-inferiority randomised controlled trial would be of benefit to decision-makers to provide further evidence on the cost-effectiveness of RALS versus CLS but may not be practical due to surgical preferences of surgeons and the extensive roll out of RALS.

Keywords: gynaecological oncology; health economics; minimally invasive surgery.

Publication types

Observational Study
Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Cost-Benefit Analysis
England
Female
Genital Neoplasms, Female*
Humans
Hysterectomy / methods
Laparoscopy* / methods
Prospective Studies
Quality of Life
Quality-Adjusted Life Years
Robotic Surgical Procedures*
Robotics*
State Medicine