Cost-effectiveness Analysis of Robotic Versus Open Pancreatoduodenectomy (DIPLOMA-2): A Multicenter International Randomized Trial.
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Menso Julia E, Bruna Caro L, de Graaf Nine, Emmen Anouk M L H, Ali Mahsoem, Björnsson Bergthor, Boggi Ugo, Busch Olivier R, Comandatore Annalisa, Daams Freek, Ferrari Giovanni, Festen Sebastiaan, van Hilst Jony, de Hingh Ignace H J T, D'Hondt Mathieu, Ielpo Benedetto, Keck Tobias, Groot Koerkamp Bas, Lips Daan J, Luyer Misha D P, Mieog J Sven, Morelli Luca, Molenaar I Quintus, Ramera Marco, Sucameli Francesco, de Wilde Roeland F, Maisonneuve Patrick, Björnelv Gudrun M W, Abu Hilal Mohammad, Besselink Marc G, Fretland Åsmund A, European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS)
Аннотация
METHODS: Predefined cost-effectiveness analysis in the international randomized DIPLOMA-2 trial (ISRCTN27483786) comparing RPD and OPD in patients with primary resectable neoplasm in 14 centers in 6 European countries (2022-2023). Primary outcomes were mean total hospital costs (euro) at 6 months postoperatively and cost-effectiveness based on costs per quality-adjusted life year (QALY; incremental cost-utility ratio). Three analyses were performed: (1) costs, (2) QALYs including Health-Related Quality of Life (HR-QoL), and (3) cost-effectiveness with probabilities at various willingness-to-pay (WTP) thresholds.
RESULTS: Overall, 268 patients were included (170 RPD, 98 OPD). No significant difference in total hospital costs was found between RPD and OPD (€30,956 vs. €28,271, P =0.538). The intraoperative costs were €5,491 higher with RPD (€11,906 vs. €6,451, P <0.001), whereas postoperative costs were €2806 lower (€19,051 vs. €21,856, P =0.518). The HR-QoL index scores were comparable at 1 and 3 months, but worse at 6 months with RPD (Δ-0.08 [-0.15 to -0.001]). Consequently, over 6 months a QALY loss was observed with RPD (Δ-0.02 [-0.07 to 0.01]) with a <30% probability of RPD being cost-effective across various WTP thresholds.
CONCLUSION: This analysis in a randomized trial found no significant differences in costs between RPD and OPD up to 6 months. Nonsignificantly lower QALYs at 6 months with RPD resulted in a <30% probability that RPD is cost-effective compared with OPD within 6 months after surgery in selected patients in high-volume centers.