Optimal Utilization of Robotic-Assisted Surgery in the NHS: A System-Level Economic Evaluation Model
Author(s)
Tzujung Lai, PhD1, Robert Heggie, PhD2, Anastasia Chalkidou, PhD3, Kathleen Anne Boyd, PhD2.
1National Institute for Health and Care Excellence, Manchester, United Kingdom, 2University of Glasgow, Glasgow, United Kingdom, 3National Institute for Health and Care Excellence, London, United Kingdom.
1National Institute for Health and Care Excellence, Manchester, United Kingdom, 2University of Glasgow, Glasgow, United Kingdom, 3National Institute for Health and Care Excellence, London, United Kingdom.
OBJECTIVES: To develop a system-level economic model to evaluate the cost-effectiveness of robotic-assisted surgery (RAS) as a shared surgical platform, supporting investment justification and identifying optimal expansion strategies across specialties to maximise efficiency and utilisation in the NHS.
METHODS: A two-stage modelling framework was developed. Stage one used decision-analytic models with a one-year time horizon for colorectal resection, hysterectomy, pancreatectomy, and prostatectomy to compare RAS with laparoscopic and open surgery, estimating incremental cost-effectiveness ratios (ICERs) based on costs and quality-adjusted life years (QALYs). Stage two integrated these results into a flexible, system-level model to explore cost-effective case-mix strategies of different procedures, RAS replacement proportions, and the impact of annual volumes ranging from 150 to 350 cases.
RESULTS: RAS consistently provided higher utility gains than both laparoscopic and open surgery, but substantial incremental costs resulted in variable cost-effectiveness across procedures. Sensitivity analyses identified utility values, length of stay, and operative time as key drivers of cost-effectiveness. Threshold analyses showed that increasing the proportion of open surgery replaced by RAS consistently reduced ICERs. Based on stage-one results, pancreatectomy can be prioritised for RAS use, followed by hysterectomy, colorectal resection, and prostatectomy. In stage two, 20 case-mix scenarios assuming 50% RAS replacement were tested across annual volumes. Strategies which allocated more RAS to procedures with greater marginal benefit were more likely to fall below the £20,000/QALY threshold. Higher annual volumes allowed capital costs to be spread across more cases, improving cost-effectiveness in several scenarios and, indicating that economies of scale play an important role.
CONCLUSIONS: RAS can be cost-effective when strategically implemented in high-volume or high-benefit procedures. This two-stage system-level modelling approach supports efficient RAS expansion by identifying optimal procedure mixes and replacement strategies. The interactive model enables dynamic scenario testing to guide planning under real-world constraints such as surgical capacity and workforce availability.
METHODS: A two-stage modelling framework was developed. Stage one used decision-analytic models with a one-year time horizon for colorectal resection, hysterectomy, pancreatectomy, and prostatectomy to compare RAS with laparoscopic and open surgery, estimating incremental cost-effectiveness ratios (ICERs) based on costs and quality-adjusted life years (QALYs). Stage two integrated these results into a flexible, system-level model to explore cost-effective case-mix strategies of different procedures, RAS replacement proportions, and the impact of annual volumes ranging from 150 to 350 cases.
RESULTS: RAS consistently provided higher utility gains than both laparoscopic and open surgery, but substantial incremental costs resulted in variable cost-effectiveness across procedures. Sensitivity analyses identified utility values, length of stay, and operative time as key drivers of cost-effectiveness. Threshold analyses showed that increasing the proportion of open surgery replaced by RAS consistently reduced ICERs. Based on stage-one results, pancreatectomy can be prioritised for RAS use, followed by hysterectomy, colorectal resection, and prostatectomy. In stage two, 20 case-mix scenarios assuming 50% RAS replacement were tested across annual volumes. Strategies which allocated more RAS to procedures with greater marginal benefit were more likely to fall below the £20,000/QALY threshold. Higher annual volumes allowed capital costs to be spread across more cases, improving cost-effectiveness in several scenarios and, indicating that economies of scale play an important role.
CONCLUSIONS: RAS can be cost-effective when strategically implemented in high-volume or high-benefit procedures. This two-stage system-level modelling approach supports efficient RAS expansion by identifying optimal procedure mixes and replacement strategies. The interactive model enables dynamic scenario testing to guide planning under real-world constraints such as surgical capacity and workforce availability.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE598
Topic
Economic Evaluation, Health Technology Assessment, Medical Technologies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas