OBJECTIVES

In 2012, robotic-assisted laparoscopic radical prostatectomy (RARP) received coverage under the national health insurance system in Japan. Our objective is to conduct cost-utility analysis of RARP in comparison with laparoscopic radical prostatectomy (LRP) and retropubic radical prostatectomy (RRP) in Japanese setting.

METHODS

We conducted cost-utility analysis of RARP for prostate cancer patient in Japan from healthcare payer prospective. The cost-effectiveness of intervention was evaluated in comparison with RRP and LRP. A lifetime time horizon and 2% discount rates for costs and outcomes were applied. A systematic review was conducted to evaluate additional benefit of RARP compared with RRP and LRP and to extract parameters used in the Markov model which was used to predict prognosis and future expenses. The model consisted of five health states; 1) surgery (initial state), 2) post surgery, 3) biochemical recurrence (BCR), 4) natural death, and 5) prostate cancer death. Monte Carlo simulation was performed with one year cycle, and ICER was calculated. A probabilistic sensitivity analysis was also conducted, and results were displayed as scatter plots and cost-effectiveness acceptability curve (CEAC).

RESULTS

ICERs per additional QALY gained of RARP were JPY937,000/QALY against RRP and JPY1,980,000/QALY against LRP, which were well below the hypothetical threshold for 1QALY in Japan, or JPY5-6,000,000 per QALY gained.

From the results of the probabilistic sensitivity analysis, under the threshold value of JPY5,000,000 and JPY6,000,000, probability of acceptance of RARP against RRP was 91.1% and 93.5%, and that of RARP against LRP was 56.9% and 57.1%.

CONCLUSIONS

From a public healthcare payer’s perspective, RARP was thought to be an cost-effective option among treatment option for prostate cancer surgeries, RRP, LRP and RARP. With all limitation, especially for lack of efficacy and QOL data in Japan and/or evidence with higher evidence level, our research could somewhat be informative for decision makers.