Cost-Effectiveness of Robotic Hysterectomy for Benign Pathology
CANSAGE ePoster Library. Nensi A. 09/27/19; 275246; eP-113
Dr. Alysha Nensi
Dr. Alysha Nensi
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Objectives:Robot-assisted hysterectomy for benign disease has similar clinical outcomes when compared to other surgical approaches, however high operative costs have been a major limitation to its adoption. This study aims to perform an updated review of the literature describing the cost-effectiveness of robotic hysterectomy for benign pathology and determine which parameters may affect decision-making surrounding the utilization of this technology in clinical practice.Methods:We searched PubMed (MEDLINE), the Cochrane Library and EMBASE (1963 – Dec 2018) and bibliographies of retrieved and relevant papers for articles addressing the cost-effectiveness of robot-assisted hysterectomy (RAH) for benign pathology relative to other surgical approaches such as laparoscopic hysterectomy (LH), vaginal hysterectomy (VH) and abdominal hysterectomy (AH).Results:A total of 253 articles were retrieved with 18 meeting inclusion criteria, including 1 RCT, 3 systematic reviews, 13 observational studies and 1 cost-minimization model. The majority of studies (13/18) reported that RAH was costlier than TLH, VH and/or AH. Two studies showed no difference in cost and 3 reported RAH as being the least costly approach. In two studies where subgroup analysis was performed following stratification by patient BMI, uterine weight and surgeon experience with performing robotic surgery, RAH was found to be more cost-effective due to fewer complications and readmissions.Conclusions:The results of this review support the findings of previous studies concluding that RAH is not cost-effective for benign pathology in general. However, emerging literature suggests that in the hands of experienced gynecologic surgeons operating on complex patients, RAH may potentially be the safer, more economical approach.
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