Cost and clinical outcomes of transoral robotic surgery versus radiation therapy for T1-2N0-1M0 pharyngeal and laryngeal cancers.

OBJECTIVES

Since 2022, transoral robotic surgery (TORS) for pharyngeal and laryngeal cancers has been covered under Japan's national health insurance system. Despite its technical advantages, such as improved access and functional preservation, its adoption remains limited. One of the barriers may be that TORS is reimbursed at the same level as conventional endoscopic surgery, despite requiring substantial initial investment and operational costs. This raises concerns about the underutilization of a potentially valuable technology. Therefore, an economic evaluation of TORS is warranted to inform reimbursement policy.

METHODS

We used data from Japan's national Diagnosis Procedure Combination (DPC) database to identify patients with T1-2N0-1M0 pharyngeal or laryngeal cancers who received either TORS or intensity-modulated radiation therapy (IMRT) in 2022. Total medical costs during the treatment period were compared.

RESULTS

Among 447 patients identified, 40 received TORS and 407 underwent IMRT. The TORS group had significantly shorter hospital stays (mean 16.3 vs. 55.5 days) and lower mean costs (1.26 vs. 3.45 million yen; P < 0.01) than those who underwent IMRT. Using a generalised linear model with a gamma distribution and log link, and adjusting for sex, age, tumour site, tumour size and nodal status, TORS was associated with significantly lower costs than IMRT (adjusted cost ratio 0.39; 95 % confidence interval 0.35-0.43; P < 0.01). A similar result was observed even when the analysis was limited to patients with oropharyngeal cancer and N0.

CONCLUSIONS

TORS demonstrated a significant reduction in medical costs for treating patients with T1-2N0-1M0 pharyngeal or laryngeal cancer. However, this result should be interpreted with caution, as the observed cost advantage is probably due to the current Japanese reimbursement pricing. Nevertheless, the shortened treatment period associated with TORS offers meaningful benefits from the patient perspective. Even with moderate adjustments in reimbursement, the cost-effectiveness of TORS is expected to remain robust.