OBJECTIVES

: This systematic literature review examined the reported cost-effectiveness and budget impact of robotic-assisted hysterectomy (RAH) versus other surgical approaches.

METHODS

: A systematic search in Pubmed, Embase, Scopus, International HTA database, and the Centre for Reviews and Dissemination (CRD) database was conducted to retrieve literature from January 1, 2010 until search date (October 26, 2020). Targeted grey literature search was also conducted. Cost-effectiveness and budget impact analysis (BIA) outcomes were collected. Methodological quality was assessed using the Consensus on Health Economic Criteria (CHEC)-Extended checklist and was classified into low, moderate, good, and excellent.

RESULTS

: There were 18 eligible publications, including 14 studies and 4 Health Technology Assessment (HTA) reports. The studies were highly heterogeneous in terms of population, type of analysis, perspective, direction of results, and quality of methodology. Of the total publications, no study scored excellent methodological quality; 50% were of moderate quality while 28% and 22% were of good and low quality.

With the limited number of studies and high heterogeneity of study characteristics, no conclusive results were observed. The incremental cost-effectiveness ratio for RAH compared to open hysterectomy for endometrial cancer varied in 2 studies ($8,041 USD/QALY in Thailand, ~$82,000 USD/QALY in Sweden). While one study in Thailand demonstrated RAH to be more costly and less effective than laparoscopic hysterectomy, 3 (out of 4) BIAs showed cost savings when the uptake of RAH increased. BIAs for gynecology oncology and mixed benign/malignant populations also showed a range of results, from cost saving (e.g., $5.0M over 15 years for hospital) to additional budget ($8.7M over 3 years for public payer).

CONCLUSIONS

: There was high heterogeneity in the cost-effectiveness and budget impact literature for RAH, leading to inconsistent results across populations, varied study quality, and uncertainty in conclusions. Further research exploring the long-term cost-utility outcomes across gynecological populations is needed.