Abstract
Background
Laparoscopic cholecystectomy is the current standard of care treatment for benign
gallbladder disease. Robotic cholecystectomy is another approach for performing cholecystectomy
that offers a surgeon better dexterity and visualization. However, robotic cholecystectomy
may increase cost without sufficient evidence to suggest an improvement in clinical
outcomes. The purpose of this study was to construct a decision tree model to compare
cost-effectiveness of laparoscopic cholecystectomy and robotic cholecystectomy.
Methods
Complication rates and effectiveness associated with robotic cholecystectomy and laparoscopic
cholecystectomy over a 1-year time frame were compared using a decision tree model
populated with data from the published literature. Cost was calculated using Medicare
data. Effectiveness was represented by quality-adjusted life-years. The primary outcome
of the study was incremental cost-effectiveness ratio, which compares the cost per
quality-adjusted life-year of the 2 interventions. The willingness-to-pay threshold
was set at $100,000/quality-adjusted life-year. Results were confirmed with 1-way,
2-way, and probabilistic sensitivity analyses varying branch-point probabilities.
Results
The studies used in our analysis included 3,498 patients who underwent laparoscopic
cholecystectomy, 1,833 patients who underwent robotic cholecystectomy, and 392 patients
who required conversion to open cholecystectomy. Laparoscopic cholecystectomy produced
0.9722 quality-adjusted life-years, costing $9,370.06. Robotic cholecystectomy produced
an additional 0.0017 quality-adjusted life-years at an additional $3,013.64. These
results equate to an incremental cost-effectiveness ratio of $1,795,735.21/quality-adjusted
life-year. This exceeds the willingness-to-pay threshold, making laparoscopic cholecystectomy
the more cost-effective strategy. Sensitivity analyses did not alter results.
Conclusion
Traditional laparoscopic cholecystectomy is the more cost-effective treatment modality
for benign gallbladder disease. At present, robotic cholecystectomy is not able to
improve clinical outcomes enough to justify its added cost.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of gallbladder stone disease.Best Pract Res Clin Gastroenterol. 2006; 20: 981-996
- Nationwide trends of hospital admissions for acute cholecystitis in the United States.Gastroenterol Rep (Oxf). 2017; 5: 36-42
- Benign gallbladder diseases: imaging techniques and tips for differentiating with malignant gallbladder diseases.World J Gastroenterol. 2020; 26: 2967-2986
- Global epidemiological trends and variations in the burden of gallbladder cancer.J Surg Oncol. 2017; 115: 580-590
- Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center.Gastrointest Endosc. 2007; 65: 247-252
- Growth in robotic-assisted procedures is from conversion of laparoscopic procedures and not from open surgeons’ conversion: a study of trends and costs.Surg Endosc. 2018; 32: 2106-2113
- National trends and outcomes of inpatient robotic-assisted versus laparoscopic cholecystectomy.Surgery. 2020; 168: 625-630
- Robot-assisted cholecystectomy is a safe but costly approach: a national database review.Am J Surg. 2019; 218: 1213-1218
- Ergonomics, user comfort, and performance in standard and robot-assisted laparoscopic surgery.Surg Endosc. 2009; 23: 1365-1371
- A short-term cost-effectiveness study comparing robot-assisted laparoscopic and open retropubic radical prostatectomy.J Med Econ. 2011; 14: 403-409
- Robot-Assisted Surgery Compared with Open Surgery and Laparoscopic Surgery: Clinical Effectiveness and Economic Analyses.Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada2011
- Robotic single-site versus laparoscopic cholecystectomy: which is cheaper? A cost report and analysis.Surg Endosc. 2016; 30: 267-272
- Robotic-assisted versus laparoscopic cholecystectomy: outcome and cost analyses of a case-matched control study.Ann Surg. 2008; 247: 987-993
- A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis.Surg Endosc. 2017; 31: 1436-1441
- The Clavien-Dindo classification of surgical complications: five-year experience.Ann Surg. 2009; 250: 187-196
- Quality of life in patients after lapa-roscopic cholecystectomy due to gallstone disease: evaluation of long-term postoperative results.Pol Przegl Chir. 2021; 93: 19-24
- Low long-term incidence of incisional hernia after cholecystectomy: a systematic review with meta-analysis.Surgery. 2021; 169: 1268-1277
- Understanding costs of care in the operating room.JAMA Surg. 2018; 153e176233
- Robot-assisted versus laparoscopic single-incision cholecystectomy: results of a randomized controlled trial.Surg Endosc. 2019; 33: 1482-1490
- Robotic-assisted versus laparoscopic cholecystectomy for benign gallbladder diseases: a systematic review and meta-analysis.Surg Endosc. 2018; 32: 4377-4392
- Laparoscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications.World J Emerg Surg. 2016; 11: 54
- Rate of complications and conversions after laparoscopic and open cholecystectomy.Med Arh. 2011; 65: 336-338
- Laparoscopic cholecystectomy: what is the price of conversion?.Surgery. 2012; 152: 173-178
- A nationwide study of conversion from laparoscopic to open cholecystectomy.Am J Surg. 2004; 188: 205-211
- Is there an optimal time for laparoscopic cholecystectomy in acute cholecystitis?.Surg Endosc. 2007; 21: 805-809
- Analysis of delayed discharge after day-surgery laparoscopic cholecystectomy.Int J Surg. 2017; 40: 33-37
- Comparison of intraoperative outcomes between single-incision robotic cholecystectomy and multi-incision robotic cholecystectomy.Cureus. 2019; 11: e5386
- QALYs: the basics.Value Health. 2009; 12: S5-S9
- Cost-effectiveness of early laparoscopic cholecystectomy for mild acute gallstone pancreatitis.Br J Surg. 2014; 101: 828-835
- Robotic versus conventional laparoscopic cholecystectomy: a comparative study of medical resource utilization and clinical outcomes.Kaohsiung J Med Sci. 2017; 33: 201-206
- Cost-effectiveness evaluation of laparoscopic versus robotic minimally invasive colectomy.Ann Surg. 2020; 272: 334-341
- A systematic review of economic evaluations of the use of robotic assisted laparoscopy in surgery compared with open or laparoscopic surgery.Appl Health Econ Health Policy. 2015; 13: 457-467
- Laparoscopic versus open cholecystectomy: a matched study.Can J Surg. 1993; 36: 330-336
- Postoperative symptoms, after-care, and return to routine activity after laparoscopic cholecystectomy.JSLS. 2010; 14: 484-489
- What is the price of life and why doesn’t it increase at the rate of inflation?.Arch Intern Med. 2003; 163: 1637-1641
- Outcomes of robotic and laparoscopic cholecystectomy for benign gallbladder disease in veteran patients.J Robot Surg. 2021; 15: 849-857
- Trends in the adoption of robotic surgery for common surgical procedures.JAMA Netw Open. 2020; 3e1918911
- The impact of robotic cholecystectomy on private practice in a community teaching hospital.Am J Surg. 2016; 211: 610-614
- The emerging role for robotics in cholecystectomy: the dawn of a new era?.Hepatobiliary Surg Nutr. 2018; 7: 21-28
- Risk factors for open conversion in minimally invasive cholecystectomy.JSLS. 2017; 21e2017.00062
- Robotic cholecystectomy: training of residents in use of the robotic platform.Int J Med Robot. 2014; 10: 88-92
- Robotic cholecystectomy is a safe educational alternative to laparoscopic cholecystectomy during general surgical training: a pilot study.J Surg Educ. 2020; 77: 1266-1270
- Can robotic surgery be done efficiently while training residents?.J Surg Educ. 2015; 72: 377-380
- Adoption of robotics in a general surgery residency program: at what cost?.J Surg Res. 2017; 213: 269-273
- Laparoscopic cholecystectomy: incidents and complications: a retrospective analysis of 9542 consecutive laparoscopic operations.HPB (Oxford). 2003; 5: 152-158
Article info
Publication history
Published online: March 11, 2023
Accepted:
January 31,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier Inc.
