Cost effectiveness of transoral robotic surgery for the treatment of oropharyngeal squamous cell carcinoma: a systematic review

Abstract

Abstract: Since the first transoral use of the da Vinci robotic surgical system in 2005 and the subsequent FDA approval for the system's use in 2009, there has been a large uptick in the number of transoral robotic surgery (TORS) procedures performed in the United States. The most common use of TORS has been in the treatment of oropharyngeal squamous cell carcinoma (OPSCC). The rise in TORS cases for OPSCC is driven in part by the epidemic of human papilloma virus (HPV)-associated OPSCC. The advantage of TORS is that it allows transoral resection of tumors previously requiring open approaches associated with longer hospitalization and recovery, and higher functional morbidity. In addition to oncologic and functional outcomes, the cost of treatments using the robot is also a consideration in determining what role TORS should have in the treatment of OPSCC. A systematic review of the literature was performed by searching for articles addressing the cost-effectiveness of TORS. We have analyzed the articles obtained and report that analysis here. The results include case series and other analyses. They suggest that TORS for OPSCC is cost-effective compared to other available modalities due to decreased hospital stay, increased chance of finding an unknown primary and thereby avoiding some adjuvant treatment, and decreased rates of gastrostomy tube and tracheotomy. The methods used for calculating costs varied widely, and studies universally lack long-term follow-up. Further studies are needed, which define and measure costs and compare TORS with open surgery and non-surgical treatments. Keywords: oropharyngeal cancer, transoral robotic surgery, da Vinci robot, cost