COST-EFFECTIVENESS ANALYSIS OF ROBOTIC VERSUS LAPAROSCOPIC SURGERY IN COLORECTAL CANCER: REAL-WORLD EVIDENCE FROM A SPANISH TERTIARY HOSPITAL
Author(s)
Carla Ortega Fernández, BSc1, David Vivas-Consuelo, PhD, MD1, José Martín Arévalo, MD2, Marc Romeu Ferras, BSc1, Vicente Pla Martí, MD2.
1Universitat Politècnica de València, Valencia, Spain, 2Hospital Clínic Universitari de València, Valencia, Spain.
1Universitat Politècnica de València, Valencia, Spain, 2Hospital Clínic Universitari de València, Valencia, Spain.
OBJECTIVES: Robotic surgery as Da Vinci surgical system is increasingly adopted in curative surgical treatment of colorectal cancer (CRC), in stages I-III, despite concerns about its economic value compared to laparoscopy, the current gold standard. This study evaluates the cost-effectiveness of robotic versus laparoscopic surgery in CRC using real-world data from a tertiary hospital.
METHODS: A retrospective observational study was conducted including 236 patients (118 per group after Propensity Score Matching) undergoing elective CRC surgery between 2022 and 2025. A decision-tree model was designed to estimate costs and health outcomes over a one-year horizon from the hospital perspective. Effectiveness was measured in quality-adjusted life years (QALYs), inferred from complication-based utility estimates. Direct healthcare costs were considered, such as procedure, hospitalization and complication management. Incremental cost-effectiveness ratio (ICER) was calculated. Uncertainty was assessed through probabilistic sensitivity analysis using Monte Carlo simulation (10,000 iterations).
RESULTS: Robotic surgery showed higher total costs compared to laparoscopy (€13,541 vs. €8,685), primarily due to the intervention's costs, with a modest increase in effectiveness (0.6318 vs. 0.6019 QALYs). The resulting ICER was €160,885/QALY, exceeding a 400% the commonly accepted willingness-to-pay thresholds in Spain (€30,000/QALY). Clinically, robotic surgery was associated with a lower rate of postoperative complications (30.2% vs. 34.7%), though differences were not statistically significant. The probability of robotic surgery being cost-effective was 23.2%. Sensitivity analysis indicated that a reduction of approximately 73.7% in consumable costs would be required for robotic surgery to reach cost-effectiveness.
CONCLUSIONS: While robotic surgery shows modest clinical benefits, it remains economically inefficient as a blanket strategy. Consequently, Da Vinci surgical system is not globally cost-effective for colorectal cancer in the short term. Future optimization requires targeted patient selection, cost reduction in dispensable materials, and long-term effectiveness studies, which may improve its value proposition in selective populations.
METHODS: A retrospective observational study was conducted including 236 patients (118 per group after Propensity Score Matching) undergoing elective CRC surgery between 2022 and 2025. A decision-tree model was designed to estimate costs and health outcomes over a one-year horizon from the hospital perspective. Effectiveness was measured in quality-adjusted life years (QALYs), inferred from complication-based utility estimates. Direct healthcare costs were considered, such as procedure, hospitalization and complication management. Incremental cost-effectiveness ratio (ICER) was calculated. Uncertainty was assessed through probabilistic sensitivity analysis using Monte Carlo simulation (10,000 iterations).
RESULTS: Robotic surgery showed higher total costs compared to laparoscopy (€13,541 vs. €8,685), primarily due to the intervention's costs, with a modest increase in effectiveness (0.6318 vs. 0.6019 QALYs). The resulting ICER was €160,885/QALY, exceeding a 400% the commonly accepted willingness-to-pay thresholds in Spain (€30,000/QALY). Clinically, robotic surgery was associated with a lower rate of postoperative complications (30.2% vs. 34.7%), though differences were not statistically significant. The probability of robotic surgery being cost-effective was 23.2%. Sensitivity analysis indicated that a reduction of approximately 73.7% in consumable costs would be required for robotic surgery to reach cost-effectiveness.
CONCLUSIONS: While robotic surgery shows modest clinical benefits, it remains economically inefficient as a blanket strategy. Consequently, Da Vinci surgical system is not globally cost-effective for colorectal cancer in the short term. Future optimization requires targeted patient selection, cost reduction in dispensable materials, and long-term effectiveness studies, which may improve its value proposition in selective populations.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA118
Topic
Economic Evaluation, Health Technology Assessment, Real World Data & Information Systems
Topic Subcategory
Decision & Deliberative Processes
Disease
Gastrointestinal Disorders, Oncology, Surgery