A cost-effectiveness modeling study of robot-assisted (RARC) versus open radical cystectomy (ORC) for bladder cancer to inform future research

European Urology Focus
Charlotte T J MichelsJanneke P C Grutters

Abstract

Open radical cystectomy (ORC) is regarded the standard treatment for muscle-invasive bladder cancer, but robot-assisted radical cystectomy (RARC) is increasingly used in practice. However, it is unclear whether RARC provides value for money. To identify the main evidence gaps and main drivers of cost-effectiveness, comparing RARC to ORC. A decision analytical model was developed to study the 30d and 90d postoperative complications with RARC versus ORC and their related cost in bladder cancer patients. Input data were derived from systematic literature searches, meta-analyses, internal databases and expert opinion. Cost per saved complication (in Clavien-Dindo grading) was determined. Deterministic sensitivity analyses was performed to search for threshold values for RARC to become cost saving. Uncertainty was addressed using probabilistic sensitivity analyses. The expected 30d and 90d risk for a minor complication was lower for RARC than ORC (37% vs. 45% and 32% vs. 36%). The expected 30d and 90d risk of RARC versus ORC for a major complication was 18% vs. 23% and 16% vs. 25%. The 30d and 90d extra costs needed to prevent one major complication were €62,582 and €37,007, respectively. Data on the impact of complications on quali...Continue Reading

Citations

Feb 12, 2021·Asian Journal of Urology·Marcio Covas MoschovasGabriel Ogaya-Pinies
Jun 14, 2021·Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research·Mirre ScholteJanneke P C Grutters
Dec 29, 2021·Neurourology and Urodynamics·Camille HaudebertBenoit Peyronnet

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