A cost-utility analysis of laparoscopic radical prostatectomy and robotic-assisted laparoscopic radical prostatectomy in men with localized prostate cancer in Thailand.

摘要

OBJECTIVE: Robotic machines are being used with increasing frequency in the treatment of clinically localized prostate cancer in Thailand. While robotics may offer some advantages, it remains unclear whether potential benefits offset higher costs. The objective of this study was to evaluate and compare cost utility between standard and robotic-assisted laparoscopic prostatectomy from a health system perspective. MATERIAL AND METHOD: The authors created a care pathway and a model to facilitate a comprehensive cost utility analysis. All variables used in our model were derived from our review of the literature, exceptfor cost, utility for erectile dysfunction, and utility for urinary incontinence, which were derived from Chulalongkorn Hospital patient records. All costs described in this report are denominated in Thai baht, with a 2012 currency value. A positive margin was used to simulate the model. Sensitivity analysis was performed to estimate the robustness of the outcome. RESULTS: Thailand utility values for erectile dysfunction and urinary incontinence were 0.86 and 0.81, respectively. The cost of robotic laparoscopy was, on average, 120,359 baht (95% CI, 89,368-151,350 baht) higher than standard laparoscopy and was more effective with a mean gain of 0.05 quality-adjusted life years (QALYs) (95% CI, 0.03-0.08) for the 100 procedures performed each year. The incremental cost effectiveness (ICER) ratio was 2,407,180 baht per QALYs, with a very low probability that robotic prostatectomy would be cost effective at the Thai-willingness-to pay (WTP) threshold of 160,000 baht/ QALY. CONCLUSION: Robotic-assisted laparoscopic prostatectomy is not more cost effective than standard laparoscopic prostatectomy for the 100 cases performed each year. An increase in the number of cases may result in better economies of scale and a lower ICER, an outcome that may increase the overall value and cost effectiveness of an investment in this technology.