Comparative Outcomes and Cost-Effectiveness of Robotic Versus Laparoscopic Partial Nephrectomy: A Nationwide Population-based Analysis in Taiwan.

BACKGROUND

This study evaluated the cost-effectiveness and clinical outcomes of robotic partial nephrectomy (RPN) versus laparoscopic partial nephrectomy (LPN) within Taiwan's National Health Insurance (NHI) system.

METHODS

A nationwide population-based cohort of renal cell carcinoma patients who underwent partial nephrectomy from January 2021 to August 2024 was analyzed. Covariate balance was achieved by using inverse probability of treatment weighting (IPTW). A Markov model estimated the incremental cost-effectiveness ratio (ICER) over a 10-year horizon, and deterministic and probabilistic sensitivity analyses assessed parameter uncertainty.

RESULTS

Among 2,675 patients, 1,510 received RPN and 1,165 received LPN. Robotic partial nephrectomy was associated with significantly lower dialysis risk at 30 days (0% vs. 1.18%; 95% confidence interval [CI] for risk difference, -1.9% to -0.5%) and 180 days (0.15% vs. 1.18%, 95% CI -1.7% to -0.2%). Readmission rates were also reduced at 14 days (0.30% vs. 3.10%, 95% CI -4.2% to -2.4%) and 30 days (3.11% vs. 7.23%, 95% CI -5.7% to -2.5%). No significant differences were found in postoperative complications, length of stay, or mortality. Long-term economic evaluation showed that RPN generated 7.31 quality-adjusted life years (QALYs) at a cost of US$22,976.9 compared with 7.29 QALYs at US$30,726.5 for LPN, yielding an ICER of -US$387,480/QALYs. Probabilistic analysis indicated RPN was cost-saving.

CONCLUSIONS

Although RPN involves higher initial procedural costs, it was associated with reduced dialysis risk, fewer readmissions, lower short-term expenditures, and dominant long-term cost-effectiveness. These findings support RPN as a high-value surgical strategy within the NHI system and underscore the need for continued real-world evidence to guide reimbursement policy.