Cost-effectiveness of robot assisted surgery for prostate cancer

Key message

Men with early-stage prostate cancer are often treated with surgical removal of the prostate and the seminal vesicle. This technique is called prostatectomy and can be performed robot assisted or with an open technique. We have evaluated the extent to which robot-assisted prostatectomy fulfills the priority setting criteria for the Norwegian health service; disease severity, resource use and health benefits. 

We have collected information on costs from various hospitals, from Helse Sør-Øst RHE and from the published literature. Based on the findings in our systematic review, we have assumed a relative risk reduction in all-cause mortality of 27% (HR 0.73, 95 % CI .0,65-0.81) when using the robot assisted technique, as compared to open surgery. In absolute numbers, this means that among men 65 years old, 24 fewer deaths will occur per 10,000 operations in the first year after surgery.  In order to o evaluate the cost-effectiveness, we have developed a simplistic health economic model. We find for men aged 65 years old:

• Prostate cancer results in an absolute loss of prognosis of 4.1 good life years (QALY).
• Robot-assisted technique results in an additional cost of NOK 43 347 from a health service perspective and a health benefit of 0.1526 QALY, which gives an ICER of NOK 284 063/QALY.

For men 70 years old, prostate cancer entails an absolute prognosis loss of 3.524 good life years (QALY). This lower severity also implies a lower opportunity cost than for the 65-year-olds. However, the benefit is also somewhat larger at 0.206 QALY, which gives a lower ICER of NOK 210 223/QALY. Conclusion on cost-effectiveness depends on the estimated clinical effectiveness of robot-assisted technique on overall mortality.