COST-EFFECTIVENESS OF ROBOTIC-ASSISTED VERSUS LAPAROSCOPIC SURGERY FOR MID-LOW RECTAL CANCER: EVIDENCE FROM A MULTICENTER RANDOMIZED TRIAL IN CHINA
Author(s)
Haoran Zhan, MASc1, Danni Xiao, MASc2, Xiaoyu Yang, MASc1, Shengwei Luo, MASc3, Gordon Liu, PhD1, Beini Lyu1;
1Peking University, Beijing, China, 2Peking Union Medical College, Beijing, China, 3Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
1Peking University, Beijing, China, 2Peking Union Medical College, Beijing, China, 3Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge, Singapore
OBJECTIVES: The Robotic vs Laparoscopic Surgery for Middle and Low Rectal Cancer (REAL) trial, a multicenter randomized clinical trial in China, reported improved long-term oncologic outcomes with robotic-assisted surgery (RAS) compared with laparoscopy. However, RAS incurs higher upfront costs, and its value remains uncertain. We evaluated the 5-year cost-effectiveness of RAS versus laparoscopic surgery for rectal cancer in China.
METHODS: We developed a decision-analytic model comprising a perioperative decision tree linked to a 5-year Markov model. Treatment effects for RAS versus laparoscopy—including perioperative complications, functional outcomes, local recurrence, and survival—were derived from the REAL trial. Cost and utility inputs were obtained from published sources, prioritizing China-specific estimates. Analyses were conducted from the healthcare system perspective and reported in 2025 US dollars (USD). Health outcomes were measured in quality-adjusted life-years (QALYs), discounted at 5% annually alongside costs. We estimated the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB) using a willingness-to-pay (WTP) threshold of three times China’s 2025 GDP per capita (USD 40,335 per QALY). Threshold analyses were performed on the robotic procedure cost.
RESULTS: In the base case, RAS produced higher QALYs (3.37 vs 3.32) and higher 5-year costs (USD 20,240.44 vs USD 18,728.97) than laparoscopic surgery. The resulting ICER was USD 28,361 per QALY, corresponding to an INMB of USD 639.22 at the specified WTP threshold, indicating RAS was cost-effective. Although RAS increased upfront surgical costs, these were partially offset by lower downstream costs for long-term complication management. In threshold analyses, assuming a laparoscopic surgery cost of USD 6,944, RAS would no longer be cost-effective when its procedure cost exceeded USD 11,055.
CONCLUSIONS: Based on effectiveness estimates from China’s multicenter randomized trial in rectal cancer surgery, RAS is likely to be cost-effective relative to laparoscopy over a 5-year horizon under WTP thresholds in China. Further sensitivity analyses will assess result robustness.
METHODS: We developed a decision-analytic model comprising a perioperative decision tree linked to a 5-year Markov model. Treatment effects for RAS versus laparoscopy—including perioperative complications, functional outcomes, local recurrence, and survival—were derived from the REAL trial. Cost and utility inputs were obtained from published sources, prioritizing China-specific estimates. Analyses were conducted from the healthcare system perspective and reported in 2025 US dollars (USD). Health outcomes were measured in quality-adjusted life-years (QALYs), discounted at 5% annually alongside costs. We estimated the incremental cost-effectiveness ratio (ICER) and incremental net monetary benefit (INMB) using a willingness-to-pay (WTP) threshold of three times China’s 2025 GDP per capita (USD 40,335 per QALY). Threshold analyses were performed on the robotic procedure cost.
RESULTS: In the base case, RAS produced higher QALYs (3.37 vs 3.32) and higher 5-year costs (USD 20,240.44 vs USD 18,728.97) than laparoscopic surgery. The resulting ICER was USD 28,361 per QALY, corresponding to an INMB of USD 639.22 at the specified WTP threshold, indicating RAS was cost-effective. Although RAS increased upfront surgical costs, these were partially offset by lower downstream costs for long-term complication management. In threshold analyses, assuming a laparoscopic surgery cost of USD 6,944, RAS would no longer be cost-effective when its procedure cost exceeded USD 11,055.
CONCLUSIONS: Based on effectiveness estimates from China’s multicenter randomized trial in rectal cancer surgery, RAS is likely to be cost-effective relative to laparoscopy over a 5-year horizon under WTP thresholds in China. Further sensitivity analyses will assess result robustness.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE466
Topic
Economic Evaluation
Disease
SDC: Gastrointestinal Disorders, SDC: Oncology