New Finding on the Cost-Effectiveness of Robotic-Assisted Lobectomy for Non-Small Cell Lung Cancer

OBJECTIVES: The objective of this study was to evaluate the long-term cost-effectiveness of robotic-assisted lobectomy (RAL) compared to video-assisted thoracoscopy (VATS) for adults with non-small-cell lung cancer (NSCLC) from the perspective of UK healthcare system, and provide new findings to the published health technology appraisal.

METHODS: Leveraged from the appraisal on robotic-assisted thoracic surgery conducted by Health Technology Wales, we developed a partition survival model in TreeAge by using 5-year survival data reported by Kneuertz et al 2020, which is the only RCT compared RAL, VATS and open thoracotomy and reported long-term oncological outcomes. Health utility data were from published literature and RAVAL trial that compared RAL and VATS from postoperative to 1-year. Cost data from the Wales HTA including perioperative cost, long-term health state costs and amortized capital and maintenance cost were retained and inflated to 2024 currency. Primary outcome was the incremental cost-effectiveness ratios (ICERs). Scenarios of applying alternative survival data and exploratory 10-year time horizon were examined.

RESULTS: Compared to VATS, RAL gained 0.5 more quality-adjusted life-year (QALY) at an additional cost of £2,793 over the 5-year time horizon, thus yielded an ICER of £5,586 per QALY from the UK healthcare system perspective. The exploratory scenarios of applying 10-year survival data derived from the Kneuertz study, and using pooled hazard ratios beyond 1-year, had further brought down the ICER to £4,913 and £4,902 per QALY, respectively.

CONCLUSIONS: We found RAL to be cost-effective at conventional willingness-to-pay threshold when compared to VATS for NSCLC from the UK healthcare system perspective, and the ICERs in various scenarios were all well below what the Wales HTA had found. The study emphasized that as long as RAL could demonstrate favorable survival and quality-of-life over VATS, it would be a cost-effective approach for NSCLC treatment in the long-term.